Purpose. To report the 12-month follow-up after big-bubble deep anterior lamellar keratoplasty (DALK) assisted by femtosecond\r\nlaser that we have called IntraBubble. Methods. A 60 kHz IntraLase femtosecond laser (Abbott Medical Optics) firstly created\r\na 30? angled intrastromal channel to insert the air injection cannula, 50 �µ above the thinnest corneal site measured by Sirius\r\nScheimpflug camera (CSO, Firenze, Italy), then performed a full lamellar cut 100 �µ above the thinnest corneal point, and from the\r\nsame corneal depth, created a mushroom incision. The lamella was removed, and the smooth cannula of Fogla was inserted into\r\nthe stromal channel and air was injected to achieve a big bubble. The follow up is 12 months, and sutures were removed by the\r\n10th postoperative month in all patients. Best Corrected Visual Acuity (BCVA), spherical equivalent and, by Sirius Scheimpflug\r\ncamera (CSO, Firenze, Italy) keratometric astigmatism were evaluated. Results. All procedures were completed as DALK except\r\n2 converted to PK because an inadvertent intraoperative macroperforation occurred. Mean postoperative BCVA was 0.8, mean\r\nspherical equivalent was -3.5�±1.7D, and mean keratometric astigmatism was 4.8�±3.1D. Conclusion. The femtosecond laser could\r\nstandardize the big-bubble technique in DALK, reducing the risk of intraoperative complications and allowing good refractive\r\noutcomes.
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