The big-bubble full femtosecond laser-assisted technique in deep anterior lamellar keratoplasty

Luca Buzzonetti, Gianni Petrocelli, Paola Valente, Giancarlo Iarossi, Roberta Ardia, Sergio Petroni, Rosa Parrilla

Research output: Contribution to journalArticlepeer-review


PURPOSE: To describe the big-bubble full femtosecond laser-assisted (BBFF) technique, which could be helpful in standardizing the big-bubble technique in deep anterior lamellar keratoplasty (DALK). METHODS: Ten eyes of 10 consecutive patients affected by keratoconus underwent the BBFF technique using the 150-kHz IntraLase femtosecond laser (Intra-Lase FS Laser; Abbott Medical Optics, Inc., Santa Ana, CA). A 9-mm diameter metal mask with a single fissure 0.7 mm wide oriented at the 12-o'clock position was positioned into the cone, over the laser glass. The laser performed a ring lamellar cut (internal diameter = 3 mm; external diameter = 8 mm) 100 μm above the thinnest point, with the photodisruption effectively occurring only in the corneal stroma corresponding to the fissure to create a deep stromal channel; subsequently, an anterior side cut created an arcuate incision, from the corneal surface to the deep stromal channel on the mask's opening site. The mask was removed and the laser performed a full lamellar cut 200 μm above the thinnest point to create a lamella. After the removal of the lamella, the air needle was inserted into the stromal channel and air was injected to achieve a big bubble. RESULTS: The big bubble was achieved in 9 eyes (all type 1 bubbles) and all procedures were completed as DALK. CONCLUSIONS: Preliminary results suggest that the BBFF technique could help in standardizing the bigbubble technique in DALK, reducing the "learning curve" for surgeons who approach this technique and the risks of intraoperative complications.

Original languageEnglish
Pages (from-to)830-834
Number of pages5
JournalJournal of Refractive Surgery
Issue number12
Publication statusPublished - Dec 1 2015

ASJC Scopus subject areas

  • Ophthalmology
  • Surgery


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