Standardized big-bubble technique in deep anterior lamellar keratoplasty assisted by the femtosecond laser

We describe a variant of the big-bubble technique in deep anterior lamellar keratoplasty (DALK) assisted by the IntraLase femtosecond laser, which we call IntraBubble. The use of the 60 kHz IntraLase femtosecond laser allows dissection of the pre-Descemet-plane lamella to a predefined corneal depth and creation of a channel in the posterior stroma 50 μm above the endothelium into which a smooth cannula for air injection can be introduced. We lengthened the channel created by the laser using a pointed dissector. Eleven consecutive patients with keratoconus were treated, and all procedures were completed as DALK. The big bubble was achieved in 8 eyes (73%). In 3 cases (27%), intraoperative microperforations occurred and the procedures were completed with hand dissection without complications. This new application of femtosecond laser technology could lead to standardization of the big-bubble technique in DALK.