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Big bubble technique dissection plane: histological and ultrastructural comparative analysis on both white and clear margin dissected corneas
Author(s) -
IRION L,
MCKEE H,
BRAHMA A,
CARLEY F
Publication year - 2012
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/j.1755-3768.2012.3436.x
Subject(s) - anatomy , dissection (medical) , cornea , stroma , descemet's membrane , lamella (surface anatomy) , corneal transplantation , medicine , ophthalmology , pathology , immunohistochemistry
Purpose Pneumodissection or 'big‐bubble' technique (BBT) is used to separate Descemet’s membrane (DM) and stroma in both deep anterior lamellar keratoplasty and Descemet’s membrane endothelial keratoplasty. It has been reported that BBT may produce two typer of bubble outlines: clear or white margin. It seems that the components of the posterior lamella obtained with each bubble rims also differ. Our aim is to compare BBT dissection plane using histological and electron microscopy (EM) analysis on eye‐bank corneas. Methods BBT was carried out on donor corneas unsuitable for transplantation for reasons other than corneal disease.Corneoscleral discs were mounted on an artificial anterior chamber and BBT was carried out using a 27G needle. 5 samples which had a bubble with white margin and 5 with clear margin were fixed in formalin and sent for histology followed by EM. Results Samples in which the edge of the bubble had a white margin showed variable residual stroma adherent to DM. When the edge of the bubble was clear no residual stroma was seen attached to a bare, smooth DM. The anterior lamellae of the cases without residual stroma were also analysed. These showed no evidence of DM elements excluding the unlikely possibility of intra‐Descemet’s dissection plane. The findings were confirmed by EM in all cases. These showed intact banded DM in all posterior lamellae but only those with a white bubble outline had attached residual stromal collagen. Conclusion In eye bank corneas the histological elements of the posterior lamella dissected using BBT can be predicted depending on the margin of the bubble obtained. Assumptions that pneumodissection in BBT routinely bares DM need to be revisited.