Type 2 big bubble deep anterior lamellar keratoplasty-serial anterior segment optical coherence tomography documentation showing resolution of bubble in the postoperative period

Manuscript received: 13.05.17; Revision accepted: 28.08.17 A 26-year-old female underwent big bubble (BB) deep anterior lamellar keratoplasty (DALK) in the left eye for advanced keratoconus. During the procedure, a Type 2 bubble (T2B) with a clear margin and extending to periphery was noticed [Fig. 1]. As manipulating T2B carries a high risk of rupture of Descemet’s membrane (DM), it was left in situ. An anterior chamber paracentesis was done. The procedure was completed by manual layer by layer dissection to get close to DM [Fig. 2]. Donor tissue was secured with interrupted 10-0 nylon sutures. Postoperative anterior segment optical coherence tomography (AS-OCT) scans were taken to document the absorption of T2B [Figs. 3-5]. The bubble got completely absorbed at the end of the first week. At the last follow-up of 4 months, the patient had an uncorrected visual acuity of 6/36 with a clear graft.