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Emilio Pedrotti,1 Erika Bonacci,1 Arianna De Rossi,1 Jacopo Bonetto,1 Chiara Chierego,1 Adriano Fasolo,1,2 Alessandra De Gregorio,3 Giorgio Marchini1 1Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Verona, 37134, Italy; 2Research Unit, The Veneto Eye Bank Foundation, Venezia, 30174, Italy; 3Ophthalmic Unit, San Bassiano Hospital, Bassano Del Grappa, 36061, Vicenza, ItalyCorrespondence: Adriano FasoloThe Veneto Eye Bank Foundation, c/o Pad. G. Rama, via Paccagnella 11, Venice, 30174, ItalyTel +390419656400Fax +390419656401Email adriano.fasolo@yahoo.itPurpose: To determine whether type 1 big-bubble (BB) formation is influenced by the sequence of incisions created with the Victus femtosecond laser (FSL) enabled with software version 3.4 (SV 3.4) during deep anterior lamellar keratoplasty (DALK).Materials and Methods: Consecutive FSL-assisted DALK BB procedures were performed on 20 human donor corneas: 10 shaped by tunnel incision followed by lamellar incision (tunnel-lamellar group, TL) and 10 in the reverse order (lamellar-tunnel group, LT). The BB type was assessed by evaluating dynamic air movement during air inflation; bubble diameter and floor thickness were measured by anterior segment optical coherence tomography.Results: Overall, a type 1 BB formed in 85% of eyes: 100% in the TL group and 70% in the LT group. In the LT group, a type 2 BB formed in 2 corneas and one cornea was perforated during cannula insertion. Type 1 BB was achieved after one attempt in 90% of eyes in the TL group and in 57% in the LT group.Conclusion: Shaping the tunnel before rather than after lamellar incision may be more effective for obtaining a type 1 BB by air injection.Keywords: deep anterior lamellar keratoplasty, femtosecond laser, big bubble, intrastromal incision, lamellar incision

A De Gregorio,1 E Pedrotti,2 G Stevan,1 A Bertoncello,1 S Morselli1 1Ophthalmic Unit, San Bassiano Hospital, Bassano del Grappa, Italy; 2Eye Clinic, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy Abstract: The recent development of new devices that are significantly less invasive, collectively termed minimally invasive glaucoma surgery, offers new perspective of intraocular pressure reduction with less risk, short operating times, and rapid recovery. The aim of this work is to provide a panoramic review of the currently published clinical data to assess the potential role of XEN gel stent (Allergan PLC, Irvine, CA, USA) in the management of glaucoma, which is the only filtering minimally invasive glaucoma surgery device that allows the subconjunctival filtration. The ab interno placement of the XEN gel stent offers an alternative for lowering intraocular pressure in refractory glaucoma as a final step, and in patients intolerant to medical therapy as an early surgical approach with minimum conjunctival tissue disruption, restricted flow to avoid hypotony, and long-term safety. Keywords: glaucoma, gel stent, minimally invasive, surgery, subconjunctival drainage

The recent development of new devices that are significantly less invasive, collectively termed minimally invasive glaucoma surgery, offers new perspective of intraocular pressure reduction with less risk, short operating times, and rapid recovery. The aim of this work is to provide a panoramic review of the currently published clinical data to assess the potential role of XEN gel stent (Allergan PLC, Irvine, CA, USA) in the management of glaucoma, which is the only filtering minimally invasive glaucoma surgery device that allows the subconjunctival filtration. The ab interno placement of the XEN gel stent offers an alternative for lowering intraocular pressure in refractory glaucoma as a final step, and in patients intolerant to medical therapy as an early surgical approach with minimum conjunctival tissue disruption, restricted flow to avoid hypotony, and long-term safety. [ABSTRACT FROM AUTHOR]