Histopathology of deep anterior lamellar keratoplasty with pneumatic dissection: The "big-bubble" technique

Pauline Lim, Jay C. Bradley, George J. Harocopos, Morton E. Smith, Mark J. Mannis

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


PURPOSE: To describe characteristic histopathologic markers in deep anterior lamellar keratoplasty (DALK) using pneumatic dissection: Anwar "big-bubble" technique. METHODS: Case reports. Deep stromal buttons from 2 patients with keratoconus who had undergone DALK surgery using the "big-bubble" technique were examined by light microscopy. RESULTS: The histopathology of excised corneal buttons demonstrated multiple intrastromal spaces consistent with air bubbles. Apical stromal thinning seen clinically was not as readily appreciated on histopathology. CONCLUSIONS: Pneumatic dissection in DALK produces diffuse intrastromal air bubbles that may mask the corneal thinning that usually characterizes keratoconus histopathologically. This is a characteristic finding of which ocular pathologists and corneal surgeons should be aware.

Original languageEnglish
Pages (from-to)579-582
Number of pages4
Issue number5
StatePublished - Jun 1 2009


  • Big bubble
  • Deep anterior lamellar keratoplasty
  • Histopathology
  • Pneumatic


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