Ophthalmic viscosurgical device–assisted incision modification for the big-bubble technique in deep anterior lamellar keratoplasty

We describe several simple modifications of the big-bubble technique to improve surgeon comfort and reduce the risk for complications, with emphasis on our ophthalmic viscosurgical device (OVD)-assisted incision technique. By coating the overlying stroma with OVD prior to entering the big bubble, space is maintained in the pre-Descemet plane. This prevents collapse of the big bubble and allows an air–OVD exchange. We have successfully used this technique in 72 consecutive cases without a perforation during the entry incision to the bubble space of the DALK procedure.Financial DisclosureNo author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.