Identification and Management of a Central Type 2 Big Bubble in Deep Anterior Lamellar Keratoplasty

Purpose: The purpose of this study was to document a case of central type 2 bubble formation during deep anterior lamellar keratoplasty and discuss its intraoperative management. Methods: A rare case of central type 2 bubble formation with no peripheral extension beyond the trephination mark was documented with operative video and concurrent intraoperative optical coherence tomography imaging. Results: The type 2 bubble was decompressed with a needle intraoperatively, and deep anterior lamellar keratoplasty was successfully performed without perforation of Descemet membrane. Conclusions: Identifying formation of a type 2 bubble during deep anterior lamellar keratoplasty is crucial in avoiding perforation of Descemet membrane. This case shows that the behavior of type 2 bubbles can be different than what has been widely reported. It is hoped that this will aid the surgeon in identifying a type 2 bubble and in properly managing it intraoperatively.