Donor cornea preparation in partial big bubble deep anterior lamellar keratoplasty
The patient was a 20-year-old Indian male with bilateral advanced keratoconus and previous hydrops in the right eye resulting in corneal scarring (). DALK was performed in the right eye and subsequently performed 1 year later in the left eye following intolerance of contact lens wear. Intraoperatively, an Anwar big bubble was attempted in both eyes after initial manual lamellar dissection, but only a partial central bubble was obtained in both eyes. In the right eye especially, the full-thickness corneal scar due to previous hydrops prevented full extension of the big bubble to the trephination edge. Therefore, the donor cornea was prepared with a tapered edge to facilitate graft-host apposition as described above. The postoperative recovery was uneventful (see for visual outcome). The postoperative result shows excellent graft-host apposition on anterior segment ocular computed tomography (Visante, Zeiss, Munich, Germany; and ) The graft with the tapered ends matches the recipient bed with the peripheral rim of residual corneal stroma from incomplete corneal stroma removal.