Needle Depth and Big-Bubble Success in Deep Anterior Lamellar Keratoplasty: An Ex Vivo Microscope-Integrated OCT Study.

Journal Article (Journal Article)

PURPOSE: To examine big-bubble (BB) formation success rates in deep anterior lamellar keratoplasty (DALK) at various corneal depths using real-time guidance from swept-source, microscope-integrated optical coherence tomography (SS-MIOCT). METHODS: The DALK procedure was performed ex vivo with 34 human donor corneoscleral buttons on pressurized artificial anterior chambers using the BB technique employed by Anwar and Teichmann. We inserted a needle under controlled ex vivo conditions to corneal depths ranging from 40% to ≥90% using real-time guidance from SS-MIOCT and injected air. BB success was then determined for each injection. RESULTS: The average needle depth for successful full BB formation was 79.9% ± 3.0% compared with 66.9% ± 2.6% for partial BB formation and 49.9% ± 3.4% for no BB formation (P < 0.0001). Expressed as stroma below the needle tip, this corresponded to 123.9 ± 20.0 μm for successful full BB formation compared with 233.7 ± 23.8 μm for partial BB formation and 316.7 ± 17.3 μm for no BB formation (P < 0.0001). All other variables tested (sex, race, age, endothelial cell density, air injected, needle angle, and central corneal thickness) did not significantly affect BB formation success rates. CONCLUSIONS: BB formation in DALK is more successful if needle insertion and air injection occur at deeper corneal depth. However, ≥90% corneal depth was not necessary in this ex vivo model of DALK. SS-MIOCT can be used to accurately guide the needle in real time.

Full Text

Duke Authors

Cited Authors

  • Pasricha, ND; Shieh, C; Carrasco-Zevallos, OM; Keller, B; Cunefare, D; Mehta, JS; Farsiu, S; Izatt, JA; Toth, CA; Kuo, AN

Published Date

  • November 2016

Published In

Volume / Issue

  • 35 / 11

Start / End Page

  • 1471 - 1477

PubMed ID

  • 27442318

Pubmed Central ID

  • PMC5067966

Electronic International Standard Serial Number (EISSN)

  • 1536-4798

Digital Object Identifier (DOI)

  • 10.1097/ICO.0000000000000948


  • eng

Conference Location

  • United States