Frequency of Complications During Preparation of Corneal Lamellae Used in Posterior Lamellar Keratoplasty Using the Pneumodissection Technique (Big Bubble)

Abstract

We identified higher endothelial cell density, shorter DPT, and the presence of corneal scars after cataract surgery as risk factors threatening successful bubble formation. The only risk factor for creating type II bubbles was higher donor age in our study.

i-PDEK: Microscope-integrated OCT–assisted pre-Descemet endothelial keratoplasty

“…In addition, a magnified comprehension of donor characteristics such as prior corneal scars allowed appropriate donor selection for PDEK. 7 Subsequently, the conversion rate to DMEK, a challenging task with younger donors due to their variable biological characteristics, was reduced to zero in the current series. Also, the tissue loss was nullified compared with 4.3% reported by Studeny et al 7 Any residual microattachments of donor lenticule with the underlying stroma were also dealt successfully with i-OCT.…”

“…7 Subsequently, the conversion rate to DMEK, a challenging task with younger donors due to their variable biological characteristics, was reduced to zero in the current series. Also, the tissue loss was nullified compared with 4.3% reported by Studeny et al 7 Any residual microattachments of donor lenticule with the underlying stroma were also dealt successfully with i-OCT. In comparison to PDEK clamp and Soper technique previously described for enhancing type 1 BB formation, i-PDEK is free from risks such as additional EC loss and mechanical trauma to the donor.…”

“…The commonly documented success rate of type 1 BB formation with a conventional ophthalmic microscope varies from 71.7% to 92.3%. [7][8][9][10] However, as seen currently, it was 100% with i-PDEK with no incidence of type 2 BB or burst bubble formation, microruptures, or premature emptying of the syringe. This may be because i-OCT improved the predictability of needle passage by precisely guiding its depth, location, and orientation even through an emphysematous cornea.…”

Comparison of Pre-Descemet Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty in Endothelial Decompensation

“…Although both methods of donor preparation are prone to donor tissue tears and losses, no such wastage was encountered in our study (the chances of unsuccessful tissue peeling during DMEK remain 2.66% while the success rate of type 1 big bubble formation during PDEK remains 71.7% to 92.3%), and intraoperative optical coherence tomography could have partly contributed to this. 9,10,[17][18][19][20][21] Besides an easy donor preparation, the PDEK grafts also witnessed easier intracameral opening, better visibility, and lesser manipulations because of the presence of PDL that converts an extremely elastic DEC to a stiffer structure, acting as a splint that prevents scrolling. This could have also contributed to reduced incidence of graft detachment and, therefore, rebubbling after PDEK in our study.…”

“…Although both methods of donor preparation are prone to donor tissue tears and losses, no such wastage was encountered in our study (the chances of unsuccessful tissue peeling during DMEK remain 2.66% while the success rate of type 1 big bubble formation during PDEK remains 71.7% to 92.3%), and intraoperative optical coherence tomography could have partly contributed to this. 9,10,17–21…”