Photo Credit: Obencem

The following is a summary of “Spike sign – To predict the formation of big bubble in deep anterior lamellar keratoplasty in advanced keratoconus,” published in the May 2024 issue of Ophthalmology by D’Souza et al.

Lamellar surgeries have transformed how we approach keratoplasties, but deep anterior lamellar keratoplasty (DALK) can be challenging for new surgeons due to its learning curve. 

Researchers conducted a retrospective study to introduce and validate the use of the radial “spike sign” as a predictor of big bubble formation during DALK surgery. The aim was to reduce the number of failed attempts and improve surgical outcomes.

They identified the ‘spike sign’ during the big bubble DALK procedure. They reviewed 104 recorded surgical videos to correlate this sign with successful big bubble formation during DALK surgery in advanced keratoconus. After injection into direct big bubble formation, the air movement was categorized into stromal emphysema without a big bubble and emphysema with the spike sign followed by a big bubble.

The results showed that the injected air in 104 video clips of DALK surgeries resulted in three formations: direct big bubble in 56 attempts, stromal emphysema without a big bubble in 18 attempts, and emphysema with the spike sign followed by a big bubble in 30 attempts. The spike sign always led to big bubble formation (30/30). No big bubble formed without a spike sign (0/18). No eyes experienced perforation during big bubble formation. 

Investigators concluded that the ‘spike sign’ identified during DALK surgery proves to be a valuable intraoperative indicator for predicting successful big bubble formation. This technique has the potential to enhance surgical precision and improve outcomes.

Source: journals.lww.com/ijo/fulltext/2024/72050/spike_sign___to_predict_the_formation_of_big.26.aspx