Air pressure changes in the creation and bursting of the type-1 big bubble in deep anterior lamellar keratoplasty: an ex vivo study

AlTaan, S.L.; Mohammed, I.; Said, D.G.; Dua, H.S.

Abstract

Purpose: To measure the pressure and volume of air required to create a big bubble (BB) in simulated deep anterior lamellar keratoplasty (DALK) in donor eyes and ascertain the bursting pressure of the BB.
Patients and methods: Twenty-two human sclera-corneal discs were used. Air was injected into the corneal stroma to create a BB and the pressure measured by means of a pressure converter attached to the system via a side port. A special clamp was designed to prevent air leak from the periphery of the discs. The pressure at which air emerged in the corneal tissue; the bursting pressure measured after advancing the needle into the bubble cavity and injecting more air; the volume of air required to create a BB and the volume of the BB were ascertained.
Results: Type-1 BB were achieved in 19 and type-2 BB in 3 eyes. The maximum pressure reached to create a BB was 96.25+/- 21.61?kpa; the mean type-1 intrabubble pressure was 10.16 +/- 3.65?kpa. The mean bursting pressure of a type-1 BB was 66.65 +/- 18.65?kpa, while that of a type-2 BB was 14.77 +/- 2.44?kpa. The volume of air required to create a type-1 BB was 0.54?ml and the volume of a type-1 BB was consistently 0.1?ml.
Conclusions: Dua's layer baring DALK can withstand high intraoperative pressures compared to Descemet's membrane baring DALK. The study suggests that it could be safe to undertake procedures such as DALK-triple with a type-1 BB but not with a type-2 BB.

Citation

AlTaan, S., Mohammed, I., Said, D., & Dua, H. (2018). Air pressure changes in the creation and bursting of the type-1 big bubble in deep anterior lamellar keratoplasty: an ex vivo study. Eye, 32(1), 146-151. https://doi.org/10.1038/eye.2017.121

• Journal Article Type: Article
• Acceptance Date: May 4, 2017
• Online Publication Date: Jun 30, 2017
• Publication Date: Jan 30, 2018
• Deposit Date: Nov 16, 2018
• Publicly Available Date: Nov 19, 2018
• Journal: Eye
• Print ISSN: 0950-222X
• Electronic ISSN: 1476-5454
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 1
• Pages: 146-151
• DOI: https://doi.org/10.1038/eye.2017.121
• Public URL: https://nottingham-repository.worktribe.com/output/1277103
• Publisher URL: https://www.nature.com/articles/eye2017121