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Purpose:

To examine big-bubble (BB) formation success rates in deep anterior lamellar keratoplasty (DALK) at various corneal depths using real-time guidance from swept-source, microscope-integrated optical coherence tomography (SS-MIOCT).

Methods:

The DALK procedure was performed ex vivo with 34 human donor corneoscleral buttons on pressurized artificial anterior chambers using the BB technique employed by Anwar and Teichmann. We inserted a needle under controlled ex vivo conditions to corneal depths ranging from 40% to≥ 90% using real-time guidance from SS-MIOCT and injected air. BB success was then determined for each injection.

Results:

The average needle depth for successful full BB formation was 79.9%±3.0% compared with 66.9%±2.6% for partial BB formation and 49.9%±3.4% for no BB formation (P< 0.0001). Expressed as stroma below the needle tip, this corresponded to 123.9 …