Small-bubble deep anterior lamellar keratoplasty technique.

Stromal disease (ectasia, opacities, scars, or melting) that occurs after penetrating keratoplasty (PK) can variously affect visual outcome.1,2 To date, even in the presence of healthy endothelium, this typeof complicationhasbeen treatedwith subsequentPK.3 Instead, the selective replacement of the diseased stroma by means of deep anterior lamellar keratoplasty (DALK) using pneumatic dissection (big bubble)hasnotbeenattempted,mainlybecauseof theextreme likelihoodof breaking thedescemetic scar at the junctionbetween the donorandhostcornea.Wedescribeanewsurgical technique (smallbubble DALK) that uses pneumatic dissection to bare Descemet membrane (DM) only in a central optical zone and predescemetic manual dissection to remove the surrounding peripheral stroma.