The Big-Bubble Full Femtosecond Laser-Assisted Technique in Deep Anterior Lamellar Keratoplasty

Abstract

Surgical Technique Luca Buzzonetti, MD; Gianni Petrocelli, MD; Paola Valente, MD; Giancarlo Iarossi, MD; Roberta Ardia, MD; Sergio Petroni, MD; Rosa Parrilla, MD To describe the big-bubble full femtosecond laser-assisted (BBFF) technique, which could be helpful in standardizing the big-bubble technique in deep anterior lamellar keratoplasty (DALK). Ten eyes of 10 consecutive patients affected by keratoconus underwent the BBFF technique using the 150-kHz IntraLase femtosecond laser (Intra-Lase FS Laser; Abbott Medical Optics, Inc., Santa Ana, CA). A 9-mm diameter metal mask with a single fissure 0.7 mm wide oriented at the 12-o'clock position was positioned into the cone, over the laser glass. The laser performed a ring lamellar cut (internal diameter = 3 mm; external diameter = 8 mm) 100 µm above the thinnest point, with the photodisruption effectively occurring only in the corneal stroma corresponding to the fissure to create a deep stromal channel; subsequently, an anterior side cut created an arcuate incision, from the corneal surface to the deep stromal channel on the mask's opening site. The mask was removed and the laser performed a full lamellar cut 200 µm above the thinnest point to create a lamella. After the removal of the lamella, the air needle was inserted into the stromal channel and air was injected to achieve a big bubble. The big bubble was achieved in 9 eyes (all type 1 bubbles) and all procedures were completed as DALK. Preliminary results suggest that the BBFF technique could help in standardizing the big-bubble technique in DALK, reducing the “learning curve” for surgeons who approach this technique and the risks of intraoperative complications. [J Refract Surg. 2015;31(12):830–834.] From the Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Rome, Italy (LB, GP, PV, GI, SP, RP); Institute of Ophthalmology, Catholic University, Rome, Italy (LB); and Institute of Ophthalmology, Tor Vergata University, Rome, Italy (RA). The authors have no financial or proprietary interest in the materials presented herein. AUTHOR CONTRIBUTIONS Study concept and design (LB); data collection (GP, RA); analysis and interpretation of data (PV, GI, SP, RP); writing the manuscript (LB, SP); critical revision of the manuscript (GP, PV, GI, RA, RP) Correspondence: Luca Buzzonetti, MD, Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc – 00050 Passoscuro (Roma), Italy. E-mail: lucabuzzonetti@yahoo.it 10.3928/1081597X-20151111-07 To describe the big-bubble full femtosecond laser-assisted (BBFF) technique, which could be helpful in standardizing the big-bubble technique in deep anterior lamellar keratoplasty (DALK). Ten eyes of 10 consecutive patients affected by keratoconus underwent the BBFF technique using the 150-kHz IntraLase femtosecond laser (Intra-Lase FS Laser; Abbott Medical Optics, Inc., Santa Ana, CA). A 9-mm diameter metal mask with a single fissure 0.7 mm wide oriented at the 12-o'clock position was positioned into the cone, over the laser glass. The laser performed a ring lamellar cut (internal diameter = 3 mm; external diameter = 8 mm) 100 µm above the thinnest point, with the photodisruption effectively occurring only in the corneal stroma corresponding to the fissure to create a deep stromal channel; subsequently, an anterior side cut created an arcuate incision, from the corneal surface to the deep stromal channel on the mask's opening site. The mask was removed and the laser performed a full lamellar cut 200 µm above the thinnest point to create a lamella. After the removal of the lamella, the air needle was inserted into the stromal channel and air was injected to achieve a big bubble. The big bubble was achieved in 9 eyes (all type 1 bubbles) and all procedures were completed as DALK. Preliminary results suggest that the BBFF technique could help in standardizing the big-bubble technique in DALK, reducing the “learning curve” for surgeons who approach this technique and the risks of intraoperative complications. [J Refract Surg. 2015;31(12):830–834.] From the Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Rome, Italy (LB, GP, PV, GI, SP, RP); Institute of Ophthalmology, Catholic University, Rome, Italy (LB); and Institute of Ophthalmology, Tor Vergata University, Rome, Italy (RA). The authors have no financial or proprietary interest in the materials presented herein. AUTHOR CONTRIBUTIONS Study concept and design (LB); data collection (GP, RA); analysis and interpretation of data (PV, GI, SP, RP); writing the manuscript (LB, SP); critical revision of the manuscript (GP, PV, GI, RA, RP) Correspondence: Luca Buzzonetti, MD, Ophthalmology Department, Bambino Gesù IRCCS Children's Hospital, Via Torre di Palidoro snc – 00050 Passoscuro (Roma), Italy. E-mail: lucabuzzonetti@yahoo.it