J Vet Sci.  2016 Sep;17(3):347-352. 10.4142/jvs.2016.17.3.347.

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

• Kim S
• Kwak JY
• Jeong M
• Seo K

• KMID: 2413134
• DOI: http://doi.org/10.4142/jvs.2016.17.3.347

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.

Keyword

big-bubble technique; corneal transplantation; deep anterior lamellar keratoplasty; dogs

MeSH Terms

Animals
Corneal Opacity/etiology/*veterinary
Corneal Transplantation/*veterinary
Descemet Membrane/*surgery
Dog Diseases/*surgery
Dogs
Male

Figure

• 

  Fig. 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.

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  Fig. 2 Slit-lamp biomicroscopy with direct diffuse illumination of the corneas under 10× magnification. (A) 12 h after surgery, (B) 7 days, (C) 14 days, (D) 21 days, (E) 28 days and (F) 150 days after surgery.

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  Fig. 3 Slit-lamp biomicroscopy with direct narrow slit (1 mm) under 10× magnification for the stroma. (A) 12 h after surgery, (B) 7 days, (C) 14 days, (D) 21 days, (E) 28 days and (F) 150 days after surgery.

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  Fig. 4 Histopathological evaluation with hematoxylin and eosin staining at 150 days after surgery. (A) The epithelium was overgrown (arrowhead) at the junction of the donor and recipient corneas. In addition, deformed stromal structures were detected at the transplant junction (black arrow). (B) The central corneal part had a normal corneal structure. A small piece of DM was left in the stroma (white arrow).

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