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Deep anterior lamellar keratoplasty of dog eyes using the big-bubble technique

View Article: PubMed Central - PubMed

ABSTRACT

This study was conducted to establish the feasibility of corneal transplantation using the big-bubble technique (BBT) to perform deep anterior lamellar keratoplasty (DALK) in three dogs. After the cornea was trephined 750 µm, 4 mL of air was injected, and the blanched stroma was removed to expose Descemet's membrane (DM). The donor corneal button, which was gently stripped off the DM, was sutured onto the bare DM of the recipient cornea. The dogs received topical antibiotics every 6 h for 7 days and 2% cyclosporine ointment every 12 h for 1 month. The eyes were examined post-operatively at 7, 14, 21, 28 and 150 days. The central portion of the transplanted cornea stayed transparent while corneal haze developed around the transplanted margin. Menace response was normal even though the transplanted cornea was edematous until 3 weeks after surgery. A marginal haze was rarely observed between the donor and recipient corneas at 150 days after the operation. A spotted haze developed in the central part of the deep stroma near the DM. Upon histopathological examination, the stroma and epithelium of the donor cornea had normal structures. Corneal transplantation using DALK with BBT can be performed in dogs preserving the healthy endothelium.

No MeSH data available.


Related in: MedlinePlus

Procedures for deep anterior lamellar keratoplasty using the big bubble technique. (A) The center of the cornea was trephined 750 µm using an 8 mm vacuum trephine. (B) A partial-thickness superficial anterior keratectomy was performed. (C) A 30-gauge needle attached to a 5 cc syringe was inserted at the base of the trephination gutter into the corneal stroma. (D) 4 mL of air were gently injected, causing Descemet's membrane (DM) to separate from the deep stroma. Intrastromal blanching was observed during this procedure. (E) A blanched stroma was incised with a 15° slit-knife to allow air to escape and collapse the bubble for stroma removal. (F) DM was exposed after excising the remaining stroma using corneal scissors. (G) After DM and endothelium were stripped off, the donor cornea was punched from the endothelial side using an 8.5 mm diameter Barron punch. (H) This prepared donor corneal button was fitted onto the exposed Descemet's plane of the recipient cornea. (I) Four cardinal sutures were used with 10-0 nylon at the 3, 6, 9, and 12 clock-hour positions. (J) A single running suture was performed with 16 to 18 bites using the same suture materials.
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Figure 1: Procedures for deep anterior lamellar keratoplasty using the big bubble technique. (A) The center of the cornea was trephined 750 µm using an 8 mm vacuum trephine. (B) A partial-thickness superficial anterior keratectomy was performed. (C) A 30-gauge needle attached to a 5 cc syringe was inserted at the base of the trephination gutter into the corneal stroma. (D) 4 mL of air were gently injected, causing Descemet's membrane (DM) to separate from the deep stroma. Intrastromal blanching was observed during this procedure. (E) A blanched stroma was incised with a 15° slit-knife to allow air to escape and collapse the bubble for stroma removal. (F) DM was exposed after excising the remaining stroma using corneal scissors. (G) After DM and endothelium were stripped off, the donor cornea was punched from the endothelial side using an 8.5 mm diameter Barron punch. (H) This prepared donor corneal button was fitted onto the exposed Descemet's plane of the recipient cornea. (I) Four cardinal sutures were used with 10-0 nylon at the 3, 6, 9, and 12 clock-hour positions. (J) A single running suture was performed with 16 to 18 bites using the same suture materials.

Mentions: The surgical procedure was performed under general anesthesia with the BBT as described by Anwar and Teichmann [4]. Before surgery, the central corneal thickness (CCT) was measured with an ultrasonic pachymeter (Pachmate DGH 55; DGH Technology, USA). The central axial cornea was trephined 750 µm with an 8 mm diameter Barron radial vacuum trephine (Katena Products, USA) to create an incision of approximately 80% thickness (panel A in Fig. 1). A partial-thickness superficial anterior keratectomy was performed by dissection with a No. 66 lamellar blade (Katena Products) (panel B in Fig. 1). A small amount of air was introduced into the anterior chamber by intracameral injection at the limbus using a 26-G needle. A 30-G needle attached to a 4 mL filled syringe with the tip manually bent to approximately 30 degrees was introduced with its bevel down into the cornea stroma through the trephination groove and advanced to the center of the cornea (panel C in Fig. 1). At this point, air was injected gently, being forced through the posterior stromal lamella along the path of least resistance, causing the DM to separate from the deep stroma (panel D in Fig. 1). A blanched corneal stroma was incised with a 15° slit-knife (Alcon Laboratories, USA) to let the air escape and collapse the bubble (panel A in Fig. 1). A corneal dissector was carefully inserted and advanced into the cleavage plane that was created until its tip approached the opposite trephination groove. Corneal scissors were used to remove the remaining corneal tissue and expose the DM (panel F in Fig. 1). The donor cornea was gently stripped off the DM and endothelium with a cellulose sponge or forceps. The donor cornea was then punched from the endothelial side with an 8.5 mm-diameter Barron punch (Katena) (panel G in Fig. 1). This prepared donor corneal button was initially sutured onto the bare DM with 4 cardinal 10-0 nylon sutures at 3, 6, 9, and 12 clock-hour positions (panels H and I in Fig. 1). There was also a single running suture with 16 to 18 bites using same suture materials (panel J in Fig. 1). At the conclusion of the surgery, gentamicin and triamcinolone were injected subconjunctivally.


Deep anterior lamellar keratoplasty of dog eyes using the big-bubble technique
Procedures for deep anterior lamellar keratoplasty using the big bubble technique. (A) The center of the cornea was trephined 750 µm using an 8 mm vacuum trephine. (B) A partial-thickness superficial anterior keratectomy was performed. (C) A 30-gauge needle attached to a 5 cc syringe was inserted at the base of the trephination gutter into the corneal stroma. (D) 4 mL of air were gently injected, causing Descemet's membrane (DM) to separate from the deep stroma. Intrastromal blanching was observed during this procedure. (E) A blanched stroma was incised with a 15° slit-knife to allow air to escape and collapse the bubble for stroma removal. (F) DM was exposed after excising the remaining stroma using corneal scissors. (G) After DM and endothelium were stripped off, the donor cornea was punched from the endothelial side using an 8.5 mm diameter Barron punch. (H) This prepared donor corneal button was fitted onto the exposed Descemet's plane of the recipient cornea. (I) Four cardinal sutures were used with 10-0 nylon at the 3, 6, 9, and 12 clock-hour positions. (J) A single running suture was performed with 16 to 18 bites using the same suture materials.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5037302&req=5

Figure 1: Procedures for deep anterior lamellar keratoplasty using the big bubble technique. (A) The center of the cornea was trephined 750 µm using an 8 mm vacuum trephine. (B) A partial-thickness superficial anterior keratectomy was performed. (C) A 30-gauge needle attached to a 5 cc syringe was inserted at the base of the trephination gutter into the corneal stroma. (D) 4 mL of air were gently injected, causing Descemet's membrane (DM) to separate from the deep stroma. Intrastromal blanching was observed during this procedure. (E) A blanched stroma was incised with a 15° slit-knife to allow air to escape and collapse the bubble for stroma removal. (F) DM was exposed after excising the remaining stroma using corneal scissors. (G) After DM and endothelium were stripped off, the donor cornea was punched from the endothelial side using an 8.5 mm diameter Barron punch. (H) This prepared donor corneal button was fitted onto the exposed Descemet's plane of the recipient cornea. (I) Four cardinal sutures were used with 10-0 nylon at the 3, 6, 9, and 12 clock-hour positions. (J) A single running suture was performed with 16 to 18 bites using the same suture materials.
Mentions: The surgical procedure was performed under general anesthesia with the BBT as described by Anwar and Teichmann [4]. Before surgery, the central corneal thickness (CCT) was measured with an ultrasonic pachymeter (Pachmate DGH 55; DGH Technology, USA). The central axial cornea was trephined 750 µm with an 8 mm diameter Barron radial vacuum trephine (Katena Products, USA) to create an incision of approximately 80% thickness (panel A in Fig. 1). A partial-thickness superficial anterior keratectomy was performed by dissection with a No. 66 lamellar blade (Katena Products) (panel B in Fig. 1). A small amount of air was introduced into the anterior chamber by intracameral injection at the limbus using a 26-G needle. A 30-G needle attached to a 4 mL filled syringe with the tip manually bent to approximately 30 degrees was introduced with its bevel down into the cornea stroma through the trephination groove and advanced to the center of the cornea (panel C in Fig. 1). At this point, air was injected gently, being forced through the posterior stromal lamella along the path of least resistance, causing the DM to separate from the deep stroma (panel D in Fig. 1). A blanched corneal stroma was incised with a 15° slit-knife (Alcon Laboratories, USA) to let the air escape and collapse the bubble (panel A in Fig. 1). A corneal dissector was carefully inserted and advanced into the cleavage plane that was created until its tip approached the opposite trephination groove. Corneal scissors were used to remove the remaining corneal tissue and expose the DM (panel F in Fig. 1). The donor cornea was gently stripped off the DM and endothelium with a cellulose sponge or forceps. The donor cornea was then punched from the endothelial side with an 8.5 mm-diameter Barron punch (Katena) (panel G in Fig. 1). This prepared donor corneal button was initially sutured onto the bare DM with 4 cardinal 10-0 nylon sutures at 3, 6, 9, and 12 clock-hour positions (panels H and I in Fig. 1). There was also a single running suture with 16 to 18 bites using same suture materials (panel J in Fig. 1). At the conclusion of the surgery, gentamicin and triamcinolone were injected subconjunctivally.

View Article: PubMed Central - PubMed

ABSTRACT

This study was conducted to establish the feasibility of corneal transplantation using the big-bubble technique (BBT) to perform deep anterior lamellar keratoplasty (DALK) in three dogs. After the cornea was trephined 750 µm, 4 mL of air was injected, and the blanched stroma was removed to expose Descemet's membrane (DM). The donor corneal button, which was gently stripped off the DM, was sutured onto the bare DM of the recipient cornea. The dogs received topical antibiotics every 6 h for 7 days and 2% cyclosporine ointment every 12 h for 1 month. The eyes were examined post-operatively at 7, 14, 21, 28 and 150 days. The central portion of the transplanted cornea stayed transparent while corneal haze developed around the transplanted margin. Menace response was normal even though the transplanted cornea was edematous until 3 weeks after surgery. A marginal haze was rarely observed between the donor and recipient corneas at 150 days after the operation. A spotted haze developed in the central part of the deep stroma near the DM. Upon histopathological examination, the stroma and epithelium of the donor cornea had normal structures. Corneal transplantation using DALK with BBT can be performed in dogs preserving the healthy endothelium.

No MeSH data available.


Related in: MedlinePlus