Deep Anterior Lamellar Keratoplasty (DALK) using the “Big Bubble” technique is a surgical milestone for treating corneal diseases like keratoconus while preserving the patient’s own healthy endothelium. The procedure involves injecting air into the deep corneal stroma to create a large cleavage plane between the stroma and Descemet’s membrane. This pneumatic dissection (the big bubble) allows the surgeon to remove the diseased stroma entirely while leaving the thin, posterior layers intact. This significantly reduces the risk of graft rejection compared to full-thickness transplants. The technique is technically demanding, as the primary challenge is achieving the bubble without perforating the delicate Descemet’s membrane, which would necessitate a conversion to a traditional penetrating keratoplasty. And it is especially challenging in this case with prior radial keratotomy.