Big-Bubble Technique for DALK

Big-bubble deep anterior lamellar keratoplasty (DALK) is a necessary skill for a corneal surgeon in order to preserve the host Descemet membrane when possible. In this video, Drs. Yong Kam and Jennifer Ling demonstrate the big-bubble DALK technique with viscoelastic-assisted magnification for placement of the needle prior to injection of air into the cornea. Deep, posterior corneal wrinkles can be visualized under the bevel of the needle as it is advanced to an appropriate depth. The needle can be advanced towards the center of the cornea using this visual cue and air is subsequently injected to create the big bubble.

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