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Deep level pneumatic dissection may improve success rate of big bubble procedure
Successful big bubble formation is possible when the cannula tip is inserted at an advanced level during pneumatic dissection, according to a study.
The retrospective, noncomparative, interventional case series included 100 patients with consecutive keratoconus. All patients underwent deep anterior lamellar keratoplasty using the big-bubble technique, followed by anterior segment optical coherence tomography.
The cannula tip was inserted deep into the peripheral stroma, advanced toward the center and retracted before an anterior segment OCT was performed.
Results showed bubble formation was achieved in 70 eyes. The remaining eyes required manual stromal dissection using a Melles spatula (DORC).
The mean stromal depth reached was 104.3 ± 34.1µm. Residual tissue thickness was significantly lower in eyes with a successful big bubble formation compared to eyes that did not achieve big bubble formation (90.4 ± 27.7 µm vs. 136.7 ± 24.2 µm; P < .01), according to the researchers.
Corneal perforation occurred in one case, resulting in the conversion to penetrating keratoplasty. Microperforations occurred in eight eyes; however, they were managed without conversion to PK. Two cases of advanced cones required manual peripheral stromal removal due to incomplete bubble formation.