Goweida Mohamed Bahgat Badawi
Department of Ophthalmology, Faculty of Medicine, Alexandria University, Egypt.
Cornea. 2015 Jun;34(6):621-4. doi: 10.1097/ICO.0000000000000407.
To evaluate the preoperative factors and intraoperative complications of the 2 bubble types formed during big-bubble deep anterior lamellar keratoplasty (DALK).
This is a retrospective review of medical records of a series of patients who underwent DALK using the big-bubble technique from September 2009 to March 2014.
A total of 134 eyes were included in this study-89 eyes with advanced keratoconus, 35 eyes with post-microbial keratitis corneal scars, 8 eyes with stromal dystrophies, and 2 eyes with post-laser in situ keratomileusis ectasia. A type 1 bubble (white margin) was achieved in 56 eyes (41.8%), whereas a type 2 bubble (clear margin) was formed in 14 eyes (10.4%) and a mixed bubble was formed in 2 eyes (1.5%). Big-bubble formation failed in 62 (46.3%). All eyes with the type 1 bubble were completed as DALK; microperforation occurred in 4 eyes. Twelve of 14 eyes with the type 2 bubble were converted to penetrating keratoplasty because of large perforations.
The type 2 bubble is more likely to form in elderly patients and those with deep corneal scars and thin corneas. Because of the high rate of conversion to penetrating keratoplasty, better surgical strategies may be needed to manage type 2 bubbles.
评估在大泡深前板层角膜移植术（DALK）过程中形成的两种气泡类型的术前因素及术中并发症。
这是一项对2009年9月至2014年3月期间采用大泡技术行DALK的一系列患者病历的回顾性研究。
本研究共纳入134只眼，其中圆锥角膜晚期89只眼，感染性角膜炎后角膜瘢痕35只眼，基质营养不良8只眼，准分子原位角膜磨镶术后角膜扩张2只眼。56只眼（41.8%）形成1型气泡（白色边缘），14只眼（10.4%）形成2型气泡（清晰边缘），2只眼（1.5%）形成混合气泡。62只眼（46.3%）大泡形成失败。所有形成1型气泡的眼均完成DALK手术，4只眼发生微小穿孔。14只形成2型气泡的眼中有12只因穿孔较大而改行穿透性角膜移植术。
2型气泡更易在老年患者以及角膜瘢痕深、角膜薄的患者中形成。由于改行穿透性角膜移植术的比例较高，可能需要更好的手术策略来处理2型气泡。
