Barcelona 2015 Programme Registration Glaucoma Day 2015 Exhibition Virtual Exhibition Satellite Meetings Hotel Booking Star Alliance

Take a look inside the London 2014 Congress


Then register to join us
in Barcelona!

Predictive factors for successful corneal dissection using the big bubble technique during deep anterior lamellar keratoplasty: an optic coherence tomography-based study

Search Abstracts by author or title
(results will display both Free Papers & Poster)

Session Details

Session Title: Cornea - Surgical III

Session Date/Time: Sunday 06/09/2015 | 14:15-16:15

Paper Time: 14:41

Venue: Room 16

First Author: : V.Borderie FRANCE

Co Author(s): :    S. Touhami   O. Sandali   L. Laroche              

Abstract Details


To analyse the predictive factors of a successful Big Bubble (BB) during Deep Anterior Lamellar Keratoplasty (DALK) using Optic Coherence Tomography (OCT).


Clinical Investigation Center 503, French National Eye Hospital, Paris, France


Retrospective review of all patients who underwent DALK by the same experienced surgeon (VB) between 2003 and 2014 at the Quinze-Vingts Hospital, Paris. For each patient, clinical and when available OCT data was collected preoperatively: corneal disease, best corrected visual acuity (BCVA), central and minimal corneal thicknesses (CT), difference between maximal and minimal (∂1) and median and minimal (∂2) CT, Sandali's OCT classification (SOC) when the pathology was keratoconus (KC) and presence of stromal scars on OCT; and perioperatively: diameter and depth of trephination. All variables were correlated to the occurrence of a successful BB.


236 patients underwent DALK during the study period: 72.5% for KC, 8.5% for corneal dystrophies, 9.7% for Herpes and 9.3% for corneal scars. Median age was 33 years (13-83). Successful BB dissection was possible in 107 cases (45%). Among the 129 cases with manual dissection, perforation occurred in 25 cases (19%). The occurrence of a BB did not correlate with age, corneal disease, BCVA, central and minimal CT or trephination diameter. It was associated with: ∂1 CT>220um (p=0.017), ∂2 CT>110um (p=0.075), SOC stage 3 or 4 KC (p= 0.03), presence of scars in the posterior stroma (p=0.0005), and trephination depth (p=0.014).


DALK has obvious advantages over penetrating keratoplasty at the cost of a steep learning curve that the BB technique has made easier to overcome. However, BB aspect is not constant even for experienced surgeons and manual dissection with a risk of perforation is often necessary when the BB fails. This study showed for the first time the value of easily available preoperative OCT parameters to predict the success of a BB and DALK outcome, which can help with the surgical decision and avoid complications especially during the procedure learning phase.

Financial Interest:


Back to previous