By Sanjib Banerjee, MBBS; Samar K. Basak, MD, FRCS, MBBS
    AAO 2014
    Cornea/External Disease

    The big-bubble technique of deep anterior lamellar keratoplasty (DALK) is a challenging yet rewarding corneal surgery. Big bubble can be a challenge in some cases. This video demonstrates how to achieve bare Descemet's membrane following failed big bubble via the help of microbubbles. After manual layer dissection, multiple, tiny, intrastromal air bubbles near Descemet's membrane are noticed during surgery. Puncturing this microbubble with a 26-gauge needle and injecting viscoelastic at this site achieved cleavage between Descemet's membrane and the remaining corneal stroma. DALK was completed with no further complications.