Early bubble modification of the big bubble technique for deep anterior lamellar keratoplasty.

PURPOSE: We modified the deep anterior lamellar keratoplasty big bubble technique to improve safety and ease of performance. METHODS: We describe a modification of the big bubble technique that involves injecting the air bubble through a peripheral corneal incision 1 mm from the limbus. The incision is made with a limbal relaxing incision knife. This is done before trephination of the recipient cornea, hence the name "early bubble." The goal of this technique is to reduce the risk of intraoperative corneal perforation and to obtain a large air bubble between Descemet membrane and the corneal stroma. We report outcomes of this technique in 21 eyes. RESULTS: At 6 months, 16 eyes showed a best-corrected visual acuity of 20/50; the remaining eyes had a best-corrected visual acuity of 20/80 or better. The postoperative corneal astigmatism was 3.6+/-0.9 diopters at 3 months and 3.15+/-0.67 diopters at 6 months. The rate of conversion to penetrating keratoplasty was 14%. CONCLUSIONS: We found that the "early bubble" technique improved the ease of performance, safety, and predictability of deep anterior lamellar keratoplasty.