{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:28:13Z","timestamp":1740126493822,"version":"3.37.3"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,8,17]],"date-time":"2017-08-17T00:00:00Z","timestamp":1502928000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2018,4]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>In this study, we examined a novel variant of \u2018big\u2010bubble\u2019 deep anterior lamellar keratoplasty using trypan\u2010blue\u2010stained viscoelastic device for the creation of a pre\u2010descemetic bubble.<\/jats:p><\/jats:sec>Methods<\/jats:title>Ten corneoscleral rims were mounted on an artificial anterior chamber (AC). The AC was filled with air through a limbal paracentesis. A Melles' triangulated spatula was inserted through the paracentesis, with its tip penetrating the AC, was then slightly retracted and pushed into the deep stroma above the roof of the paracentesis. A mixture of trypan blue and viscoelastic device (Healon, Abbott Medical Optics, Abbott Park, Illinois) was injected into this intra\u2010stromal pocket using a 27\u2010G cannula to create a pre\u2010descemetic separation bubble. Bubble type and visualization of dyed viscoelastic device were noted. The method was later employed in three cases.<\/jats:p><\/jats:sec>Results<\/jats:title>In all 10 corneoscleral rims, the technique successfully created a visible pre\u2010descemetic (type 1) bubble that could be expanded up to the predicted diameter of trephination. Subsequent trephination and the removal of corneal stroma were uneventful. In two out of four clinical cases, a type 1 bubble was created, while in two others, visco\u2010dissection failed and dyed viscoelastic was seen in the AC.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The presented technique holds promise of being a relatively easy to perform, predictable and well\u2010controlled alternative for achieving a type 1 bubble during deep anterior lamellar keratoplasty surgery. The trypan\u2010blue\u2010stained viscoelastic device facilitates proper visualization and control of the separation bubble and assists in identifying the penetrance to the separation bubble prior to removal of the stromal cap.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.13017","type":"journal-article","created":{"date-parts":[[2017,7,3]],"date-time":"2017-07-03T19:22:37Z","timestamp":1499109757000},"page":"275-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["\u2018Blue bubble\u2019 technique: an ab interno<\/i> approach for Descemet separation in deep anterior lamellar keratoplasty using trypan blue stained viscoelastic device"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3398-5905","authenticated-orcid":false,"given":"Eitan","family":"Livny","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Rabin Medical Center Petach Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irit","family":"Bahar","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Rabin Medical Center Petach Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naama","family":"Hammel","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Vision Science University of California Davis CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoav","family":"Nahum","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Rabin Medical Center Petach Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,8,17]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/B978-0-323-06387-6.00137-9","volume-title":"Cornea","author":"Fontana L","year":"2011"},{"doi-asserted-by":"publisher","key":"e_1_2_5_3_1","DOI":"10.1016\/S0886-3350(01)01181-6"},{"doi-asserted-by":"publisher","key":"e_1_2_5_4_1","DOI":"10.1016\/j.ophtha.2012.08.041"},{"doi-asserted-by":"publisher","key":"e_1_2_5_5_1","DOI":"10.1136\/bjophthalmol-2013-304585"},{"key":"e_1_2_5_6_1","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/ICO.0000000000000413","article-title":"Pachymetry\u2010guided intrastromal air injection (\u201cpachy\u2010bubble\u201d) for deep anterior lamellar keratoplasty: results of the first 110 cases","volume":"34","author":"Ghanem RC","year":"2015","journal-title":"Cornea"},{"key":"e_1_2_5_7_1","article-title":"Outcomes of air injection within 2\u00a0mm inside a deep trephination for deep anterior lamellar keratoplasty in eyes with keratoconus","author":"Busin M","year":"2016","journal-title":"Am J Ophthalmol"},{"doi-asserted-by":"publisher","key":"e_1_2_5_8_1","DOI":"10.1136\/bjo.83.3.327"},{"doi-asserted-by":"publisher","key":"e_1_2_5_9_1","DOI":"10.1001\/archopht.117.11.1561"},{"doi-asserted-by":"publisher","key":"e_1_2_5_10_1","DOI":"10.1097\/ICO.0b013e31826cbe99"},{"key":"e_1_2_5_11_1","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0886-3350(13)80445-2","article-title":"Fluorescent viscoelastic enhancement","volume":"18","author":"Smith KD","year":"1992","journal-title":"J Cataract Refract Surg"},{"key":"e_1_2_5_12_1","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/S0886-3350(02)01594-8","article-title":"Trypan\u2010blue\u2010stained viscoelastic material for ophthalmic surgery","volume":"28","author":"Nouhuijs HM","year":"2002","journal-title":"J Cataract Refract Surg"},{"doi-asserted-by":"publisher","key":"e_1_2_5_13_1","DOI":"10.1136\/bjo.2006.113357"},{"doi-asserted-by":"publisher","key":"e_1_2_5_14_1","DOI":"10.1016\/j.jcrs.2013.12.020"},{"doi-asserted-by":"publisher","key":"e_1_2_5_15_1","DOI":"10.1097\/ICO.0b013e31826429d5"},{"doi-asserted-by":"publisher","key":"e_1_2_5_16_1","DOI":"10.1097\/ICO.0b013e3182a1bc49"}],"container-title":["Clinical & Experimental Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fceo.13017","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ceo.13017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T12:18:59Z","timestamp":1695557939000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ceo.13017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,17]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1111\/ceo.13017"],"URL":"https:\/\/doi.org\/10.1111\/ceo.13017","archive":["Portico"],"relation":{},"ISSN":["1442-6404","1442-9071"],"issn-type":[{"type":"print","value":"1442-6404"},{"type":"electronic","value":"1442-9071"}],"subject":[],"published":{"date-parts":[[2017,8,17]]},"assertion":[{"value":"2017-04-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-06-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-08-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}