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Feature Products >> Anwar 'Big Bubble' Deep Lamellar Technique


Dr Anwar's deep lamellar technique, 'Big Bubble', involves generating a big air bubble between the stroma and Descemet's membrane. Removal of the stroma exposes the smooth Descemet's membrane. The following instruments have been developed with Dr Anwar by Duckworth & Kent for his technique.

Big Bubble Deep Lamellar Technique, Dr Mohammad Anwar, FRCS
1. Use the Anwar Keratoplasty 16 Blade Ring Marker (ref: 9-735-1) on the cornea.
2. Partial trephination (300 microns) with pre-set depth.
3. Place a dab of visco elastic on the corneal surface.
4. Insert a bent 27G needle bevel down deep in the corneal groove.
5. A needle is advanced deep in the paracentral direction deep in the stroma at about 80% depth.
6. The needle is already attached with an air filled syringe.
7. Press the plunger with some force.
8. The bubble appears instantly and is recognized by a white circular band.
9. The stroma anterior to the bubble is removed with a blade.
10. A paracentesis is done peripheral to the bubble and the aqueous fluid egressed.
WARNING: Videos may contain actual surgery footage;
this can be graphic and unsuitable for some people.
11. The cavity of the bubble is penetrated with the sharp blade (30°).
12. The knife is withdrawn and the bubble collapses.
13. The Anwar Keratoplasty Spatula (ref: 6-099-3) is inserted into the cavity of the bubble through the opening created by the sharp blade.
14. The stroma above the spatula is sliced with the blade. The Descemet's membrane is now exposed.
15. Using the Anwar Keratoplasty Left & Right Scissors (ref: 1-218 & 1-219) the residual stroma is removed in two halves.
16. The Descemets membrane is stripped off the donor button.
17. The donor is sutured into place with 10/0 nylon sutures and the tension adjusted using a keratoscope.
16 blade corneal marker, ref: 9-735-1, and hook, ref: 6-112
 16 regularly spaced peripheral radial marks on the cornea
 Spatula, ref: 6-099-3, allows tenting up of final corneal lamella for a safe split by a sharp metal blade Scissors, ref: 1-218, being used for removal of final corneal lamella

Anwar Keratoplasty Instrument Set (click on the product codes for more information)
Code Product Name Info
9-735-1 Anwar Keratoplasty 16 Blade Ring Marker
Marking the cornea.
6-112 Anwar Keratoplasty Hook
Creating centre mark through 9-735-1 Anwar Keratoplasty 16 Blade Ring Marker.
6-099-3 Anwar Keratoplasty Spatula
Allows tenting up of final corneal lamella.
1-218 Anwar Keratoplasty Scissors - Right
Blunt tips, 5.0mm cut, round handle.
1-219 Anwar Keratoplasty Scissors - Left
Blunt tips, 5.0mm cut, round handle.

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