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Advanced DALK Techniques: Mushroom Mini Big Bubble DALK

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Modern Keratoplasty

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

Deep anterior lamellar keratoplasty (DALK) carries advantages over penetrating keratoplasty (PK) by eliminating donor endothelial rejection and graft decompensation, the leading cause of PK failure. Consequently, DALK in conditions with a healthy host endothelium such as keratoconus improves graft survival. However, DALK is a difficult surgery with a high intraoperative conversion rate to PK due to Descemet membrane (DM) particularly during peripheral DM baring. Through automating stages of DALK with a femtosecond laser to create a 3D mushroom configuration and utilizing a mini big bubble to reduce the area of DM baring to within the confines of the pre-Descemet layer, the risk of intraoperative perforation and conversion to PK can be reduced.

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Author information

Authors and Affiliations

  1. Department of Corneal and External Diseases, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

    Kunal A. Gadhvi

  2. Department of Corneal and External Eye Diseases, Moorfields Eye Hospital, London, UK

    Bruce D. Allan

Authors
  1. Kunal A. Gadhvi
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  2. Bruce D. Allan
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Corresponding author

Correspondence to Kunal A. Gadhvi .

Editor information

Editors and Affiliations

  1. Vissum Miranza, Miguel Hernández University, Alicante, Spain

    Jorge L. Alió

  2. Vissum-Instituto Oftalmologico de Alica, Miguel Hernandez University, Alicante, Alicante, Spain

    Jorge L. Alió del Barrio

Electronic Supplementary Material

Here is a video of a Femto DALK procedure being performed using the mini big bubble technique described in this chapter (MP4 175106 kb)

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© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

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Gadhvi, K.A., Allan, B.D. (2023). Advanced DALK Techniques: Mushroom Mini Big Bubble DALK. In: Alió, J.L., del Barrio, J.L.A. (eds) Modern Keratoplasty. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-32408-6_22

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  • DOI: https://doi.org/10.1007/978-3-031-32408-6_22

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-32407-9

  • Online ISBN: 978-3-031-32408-6

  • eBook Packages: MedicineMedicine (R0)

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