DALK is a novel technique of removing the stroma of the host cornea and retaining the descemet layer and endothelium thereby giving immune privilege and early visual rehabilitation in patients with keratoconus or stromal corneal dystrophies. Air bubble injection in the deep stroma to achieve type 1 bubble is a key step in achieving the right plane of dissection of stroma from descemet and endothelium. When the air bubble enters between the stroma and Dua’s layer , it leads to formation of type 1 bubble while if the air bubble enters the space between Dua’s layer and endothelium , it leads to formation of type 2 bubble thus leaving the bare endothelial layer. Formation of type 1 bubble is seen to have more favorable outcomes in terms of successful completion of DALK. On contrary formation of Type 2 bubble in most of the time associated with perforation. Thus this video demonstrates the way to go about and to improvise the technique and procedure of DALK if one achieve Type 2 bubble.
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