Premium
Dynamics of big bubble formation in deep anterior lamellar keratoplasty by the big bubble technique: in vitro studies
Author(s) -
Dua Harminder S,
Faraj Lana A,
Kenawy Mohamed B,
AlTaan Saief,
Elalfy Mohamed S,
Katamish Tarek,
Said Dalia G
Publication year - 2018
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13460
Subject(s) - stroma , lamellar granule , anatomy , lamellar structure , air bubble , cornea , stromal cell , materials science , ultrastructure , chemistry , biology , pathology , ophthalmology , medicine , crystallography , composite material , immunohistochemistry
Abstract Purpose To examine the movement of air injected in the cornea in simulated deep anterior lamellar keratoplasty ( DALK ), from the needle tip to the formation of different types of big bubbles ( BB ) and to ascertain how air travels through the stroma and pre‐Descemet's layer [Dua's layer ( PDL )] to create a type‐1 (air between PDL and deep stroma) and type‐2 BB (air between PDL and Descemet's membrane). Methods Air was injected in 57 sclerocorneal discs and the passage recorded. Leaking points and sites of commencement of type‐1 and type‐2 BB were examined by scanning electron microscopy. Stromal distribution of air pockets was studied by light microscopy. Uninjected corneas served as controls. Results Injected air followed a consistent pattern, initially as radial tracks to the limbus, then as circumferential bands along the limbus and finally centripetally to create predominantly a type‐1 BB . Type‐2 BB started at the periphery, by air emerging through clusters of tiny fenestrations discovered in the periphery of PDL . Fifteen to 20 such clusters were also seen in control samples on either side of the Descemet's attachment. Type‐1 BB was formed by air emerging through wide spaces between lamellae of deep stroma. Histologically, the circumferential band revealed an aggregation of air pockets in the mid‐stroma. Conclusion The consistent pattern of passage of air is indicative of the architecture and microanatomy of the corneal stroma where collagen lamellae are orthogonally arranged centrally and as a circular annulus at the periphery. The novel peripheral fenestrations explain the peripheral commencement of a type‐2 BB and the escape of air into the anterior chamber during DALK .