| Summary: | Emilio Pedrotti,1 Erika Bonacci,1 Arianna De Rossi,1 Jacopo Bonetto,1 Chiara Chierego,1 Adriano Fasolo,1,2 Alessandra De Gregorio,3 Giorgio Marchini1 1Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Verona, 37134, Italy; 2Research Unit, The Veneto Eye Bank Foundation, Venezia, 30174, Italy; 3Ophthalmic Unit, San Bassiano Hospital, Bassano Del Grappa, 36061, Vicenza, ItalyCorrespondence: Adriano FasoloThe Veneto Eye Bank Foundation, c/o Pad. G. Rama, via Paccagnella 11, Venice, 30174, ItalyTel +390419656400Fax +390419656401Email adriano.fasolo@yahoo.itPurpose: To determine whether type 1 big-bubble (BB) formation is influenced by the sequence of incisions created with the Victus femtosecond laser (FSL) enabled with software version 3.4 (SV 3.4) during deep anterior lamellar keratoplasty (DALK).Materials and Methods: Consecutive FSL-assisted DALK BB procedures were performed on 20 human donor corneas: 10 shaped by tunnel incision followed by lamellar incision (tunnel-lamellar group, TL) and 10 in the reverse order (lamellar-tunnel group, LT). The BB type was assessed by evaluating dynamic air movement during air inflation; bubble diameter and floor thickness were measured by anterior segment optical coherence tomography.Results: Overall, a type 1 BB formed in 85% of eyes: 100% in the TL group and 70% in the LT group. In the LT group, a type 2 BB formed in 2 corneas and one cornea was perforated during cannula insertion. Type 1 BB was achieved after one attempt in 90% of eyes in the TL group and in 57% in the LT group.Conclusion: Shaping the tunnel before rather than after lamellar incision may be more effective for obtaining a type 1 BB by air injection.Keywords: deep anterior lamellar keratoplasty, femtosecond laser, big bubble, intrastromal incision, lamellar incision
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