Viscoelastic-Assisted Dissection For The Management Of Intraoperative Deflation Of A Type 1 Big Bubble Dalk

To describe a method for managing intraoperative deflation of type 1 big bubble (BB) in deep anterior lamellar keratoplasty (DALK) surgery.

Ospedali Privati Forlì, "Villa Igea", Forlì, Italy.

This study included two eyes of two patients who underwent DALK for keratoconus and developed deflation of type 1 big bubble during pneumatic dissection using a 27-gauge air injection cannula. Surgical management and outcomes were reported.

Following deflation of the type 1 big bubble, superficial lamellar keratectomy was performed. The air injection cannula connected to a syringe containing ophthalmic viscoelastic device (OVD) was inserted from the base of the 9mm trephination into the same stromal track used for the pneumatic dissection. In both cases, gentle injection of a limited amount of OVD into the deep stroma resulted in a localized reinflation of the type 1 big bubble outside the visual axis. The roof of the resulting visco-bubble was incised and both surgeries were successfully completed as in our standardized big bubble DALK technique. Postoperatively, the graft-host interface was clear with no interface haze. Double anterior chamber formation was not observed.

Injection of viscoelastic allows successful management of intraoperative deflation of type 1 big bubble. Limited injection of OVD permits safe excision of the deep corneal stroma and allows successful completion of big bubble DALK without the risk of developing visually significant interface haze.