Sarnicola air-visco bubble technique in deep anterior lamellar keratoplasty

Orkun Muftuoglu, Patricia Toro, Robert N Hogan, Robert W Bowman, Harrison D Cavanagh, James P McCulley, Venkateswara Mootha, Vicenzo Sarnicola

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


PURPOSE:: The purpose of this study was to describe a new modification for big-bubble deep anterior lamellar keratoplasty (DALK) using pneumatic pressure to detach Descemet membrane (DM) via air injection followed by ophthalmic viscoelastic device (OVD) injection. METHODS:: After failure of big-bubble formation after air injection, OVD was injected from a different site other than the previous air injection using a 27-gauge cannula to detach DM, called air-visco bubble (AVB) DALK technique. The technique was used in 7 human corneoscleral rims that were investigated with anterior segment optical coherence tomography and histopathology and in 69 eyes that underwent DALK surgeries. RESULTS:: Big-bubble formation was noted in 4 of 7 of the donor corneoscleral rims. The anterior segment optical coherence tomography showed big-bubble formations together with intrastromal OVD accumulation. The histology of the donor corneas showed microdetachments at the DM in the periphery, deep intrastromal separation, and big-bubble formation filled with OVD. One hundred forty-one of 210 eyes (67%) underwent successful DALK with only air injection, and 69 of 210 eyes (33%) underwent AVB technique when a big bubble was not achieved with only air injection. All the corneas showed a clear interface with good wound healing when DM was bared with the AVB DALK technique. CONCLUSIONS:: Additional OVD injection to detach DM may be useful in cases where air injection fails. Also, creating small DM detachments with air injection may facilitate the formation of a big bubble with further OVD injection.

Original languageEnglish (US)
Pages (from-to)527-532
Number of pages6
Issue number4
StatePublished - Apr 1 2013


  • Descemet membrane detachment
  • air and ophthalmic viscoelastic device injection
  • deep anterior lamellar keratoplasty

ASJC Scopus subject areas

  • Ophthalmology


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