We read with interest the paper by Anwar et al. 1 The authors have described a technique to bare Descemet’s membrane (DM) by multiple lamellar dissection of the deep corneal stroma when stromal injection of air fails to achieve a big bubble (BB) in …

Type-1 BB was more likely to be seen in patients with superficial corneal scarring, granular, and lattice dystrophies, while corneas with deep scarring and macular dystrophy had more type-2 BB. The type of bubble was not associated with age and gender of the patients.

The aim of this work was to understand the dynamics of big bubble formation in the context of the known architecture of the cornea stroma, ascertain how type 1 (air between deep stroma and...

Type 2 BB is formed when an air bubble completely separates DM from the stroma and no residual stroma is adherent to DM. This has classically been characterized as having thin and clear margins without feathery edges and forming in the peripheral cornea as opposed to centrally as seen in type 1 BB.

Jan 17, 2015 · 2) Type 2 BB wherein the DM is separated from the posterior surface of DL by the air bubble. This BB is larger with a thinner wall and more susceptible to tears and bursting.

Results: Type-1 BB was achieved in 147 eyes (45.7%), whereas type-2 BB was formed in 109 eyes (33.9%). The overall success rate of BB formation was 82.9%. Type-1 BB formation in keratoconus patients was significantly higher than type-2 BB (83.8% vs 2.6%, p < 0.001).

Oct 12, 2023 · Identifying formation of a type 2 bubble during deep anterior lamellar keratoplasty is crucial in avoiding perforation of Descemet membrane. This case shows that the behavior of type 2 bubbles can be different than what has been widely reported.

Type 1 BB is the preferred bubble after pneumodissection Type 2 BB is a surgical challenge that should be managed with one of the manual dissection techniques to avoid DM baring

DM baring techniques should be avoided in eyes with type 2 BB. Instead, deep stromal dissection searching for an incomplete type 1 bubble or using one of the manual dissection techniques as a guide to the clear pre-Descemetic stroma is safer and more reliable.

May 13, 2017 · A 26-year-old female underwent big bubble (BB) deep anterior lamellar keratoplasty (DALK) in the left eye for advanced keratoconus. During the procedure, a Type 2 bubble (T2B) with a clear margin and extending to periphery was noticed [Fig. 1].