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Curvature and pachymetry maps may guide the location and deepness of the cannula used to form the big bubble type 1 in deep anterior lamellar keratoplasty (DALK)

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Session Details

Session Title: Presented Poster Session: Cornea: Surgical

Venue: Poster Village: Pod 3

First Author: : N.Cesario Pereira BRAZIL

Co Author(s): :    C. Arce   H. Pfluck   L. Bocchese   L. Sampaio   A. Forseto           

Abstract Details


To present the reasoning of how 10-mm-diameter anterior tangential and pachymetry maps from the dual Scheimpflug and Placido corneal analyzer may guide and make simpler the formation of a big bubble type 1 during DALK


The Eye Bank & Ophthalmic Hospital of Sorocaba, Sorocaba, Sao Paulo, Brasil


With the 1D-CGA-German scale of Galilei we identified more frequently an extreme peripheral flat zone in corneas with keratoconus. Such blue flat zone is very different than the central orange-red ectasic zone and both are separated by a narrow yellow-green normal zone in maps. We use videos to show the air injection and formation of the big bubble during Galilei Guided-DALK performed in eyes with keratoconus. Location of the cannula was guided by the curvature and pachymetry maps within the yellow-green zone that surrounds the central ectasic orange-red zone, far from the thinnest point, and at a suggested local depth


The extreme flattening peripheral (blue) observed on anterior tangential maps seemed related with the peripheral Dua layer which does not separate easy. On the other hand, the central ectasic (orange-red) zone delimited by the yellow-green normal zone seemed related with the central Dua layer that is easier separated from the rest of stroma by air injection. Selecting a location within the narrow yellow-green intermediary zone, we found less resistance to form type 1 or mixed big-bubble when air is injected. Our results suggest that an air injection on peripheral flat zones give more probabilities to produce big bubble type 2


Our findings support the suggestion that the central ectasic zone observed in these Galilei 10-mm-diameter anterior tangential maps with the suggested color scale, from corneas with keratoconus is related with the formation of the type 1 and mixed big-bubble, while the peripheral flatter zone may correspond to the peripheral Dua layer which is more difficult to separate from the rest of the stroma and has more resistance to the air injection. We found that there are more probabilities to form the preferred big-bubble type 1 when the tip is located at a selected yellow-green place observed in these Galilei maps

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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