Double-bubble technique to facilitate Descemet membrane exposure in deep anterior lamellar keratoplasty
Received 7 June 2009; received in revised form 27 August 2009; accepted 31 August 2009.
Safe and efficient exposure of Descemet membrane is the key to success in deep anterior lamellar keratoplasty. Although widely used, the big-bubble technique has the drawback of difficulty in maintaining appropriate needle insertion depth in the corneal stroma, resulting in injected air sometimes escaping to the peripheral cornea without separation of Descemet membrane. We describe a variation of the big-bubble technique in which air is injected into the anterior chamber before it is injected into the stroma. By observing the reflection created on the surface of the air, a needle can be inserted deep into the stroma without puncturing Descemet membrane. This allows safe and efficient separation of Descemet membrane. Moreover, air in the anterior chamber can be used as an indicator of successful Descemet membrane separation as air is shifted to the periphery with creation of the big bubble.
Financial Disclosure
The author has no financial or proprietary interest in any material or method mentioned.
From the Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. Jeremy Williams, MD, Tokyo Dental College, helped with the language in the manuscript
Corresponding author: Jun Shimazaki, MD, PhD, Department of Ophthalmology, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan.
ABSTRACT