Group 1: Twenty five eyes for which a deep anterior lamellar keratoplasty was done using double bubble modification of the big bubble technique as described by Foroutan and Dastjerdi (2007). All cases were operated by a single experienced anterior segment surgeon. The recipient operative procedure was done first before stripping the descement membrane from the donor so as not to lose the graft if large DM perforation occurred and the surgeon decided to covert to PKP and it was done as follows:
1- Moxifloxacin HCl ophthalmic solution 0.5% was administrated for one to two days preoperatively, four times daily, to reduce the risk of infection.
2- All patients were operated under general anesthesia.
3- Sterilization of the surgical field with Betadine 10% solution
4- Insertion of drape to isolate the globe from
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By the time that the air extends peripherally to the trephine groove, formation of a bubble is very unlikely and we stopped injecting air. This preserves some clear areas of corneal tissue (i.e., regions where the air has not yet penetrated), and also prevents air from entering the AC through the trabecular meshwork. We did not give up; the procedure was repeated once or twice in clear region of cornea until we get a sufficient bubble. Here we checked the IOP again.
19- Superficial keratectomy using Crescent knife bevel up started at the trephination edge going through the bed of trephination to the other end removing the superficial part of the cornea
20- The planned penetration point was determined and the bubble was punctured with a 15° slit-knife to allow escape of the air and collapse of the bubbleViscoelastic material was injected to slow sudden collapse of the bubble and to keep Descemet’s membrane away from manipulations. After puncturing of the bubble the other bubble in the A.C shifted to the