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P. Lim, J. C. Bradley, G. J. Harocopos, M. E. Smith, M. J. Mannis; Histopathology of Deep Anterior Lamellar Keratoplasty Using the "Big-Bubble" Technique. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1968.
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To describe the histopathology of deep anterior lamellar keratoplasty (DALK) using the "big-bubble" technique.
Deep stromal buttons from two keratoconus patients who had undergone DALK surgery using the "big-bubble" technique were examined by light microscopy. Surgical and clinical history of these patients were also reviewed.
In both cases, histopathology showed diffuse intrastromal spaces consistent with air bubbles. The apical stromal thinning that characterizes keratoconus was not readily appreciated.
To our knowledge, this is the first report on the histopathology of DALK specimens using the "big bubble" technique. Because the corneal emphysema induced by the procedure can mask typical histologic findings of keratoconus, such as apical stromal thinning, it is important to specify the surgical technique used and make the pathologist aware of this iatrogenic effect.
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