Dua Harminder S, Mastropasqua Leonardo, Faraj Lana, Nubile Mario, Elalfy Mohamed S, Lanzini Manuela, Calienno Roberta, Said Dalia G
Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
National High Technology Center in Ophthalmology, Univeristy "G. d'Annunzio" in Chieti-Pescara, Chieti, Italy.
Acta Ophthalmol. 2015 Aug;93(5):427-430. doi: 10.1111/aos.12714. Epub 2015 Mar 30.
In big bubble (BB), deep anterior lamellar keratoplasty intracorneal injection of air separates Descemet's membrane (DM) and the pre-Descemet's layer (Dua's layer [DL]) to create a type 1 BB. We tested the hypothesis that air injection after excision or ablation of DL will fail to produce a BB.
Nine human sclero-corneal discs were used. Three served as controls. In three, a type 1 BB was created, the bubble wall was excised and more air injected in an attempt to create another BB. In three samples, the DM was removed and 22μ of posterior cornea were ablated by phototherapeutic keratectomy (PTK). Air was injected to induce formation of a BB. Tissue from these experiments was subjected to light and electron microscopy.
In all three control eyes, a type 1 BB (DL + DM) was obtained. Air injection after excision of the type 1 BB wall in three samples failed to produce another BB. Following PTK of DL, injection of air failed to create a BB in all three samples. Multiple points of air leak from the deep stroma were observed in all six samples. Light and electron microscopy showed a clear distinction between the ablated and non-ablated areas of cornea.
This study supports the hypothesis that a BB cannot be created once the DL is excised or ablated. This adds to evidence that DL is unique. It also demonstrates that DL is not a random separation of deep stroma of the cornea.
在大泡性角膜病变（BB）中，深板层角膜移植术中向角膜内注射空气可分离Descemet膜（DM）和Descemet膜前层（Dua层[DL]），从而形成1型BB。我们检验了以下假设：切除或消融DL后注射空气将无法产生BB。
使用了9个人类巩膜角膜片。3个作为对照。在3个样本中，创建了1型BB，切除泡壁并注入更多空气以尝试创建另一个BB。在3个样本中，去除DM并通过光治疗性角膜切削术（PTK）消融22μ的后角膜。注入空气以诱导BB形成。对这些实验的组织进行光学和电子显微镜检查。
在所有3只对照眼中，均获得了1型BB（DL + DM）。在3个样本中切除1型BB壁后注射空气未能产生另一个BB。在DL进行PTK后，所有3个样本中注入空气均未能形成BB。在所有6个样本中均观察到来自深层基质的多个空气泄漏点。光学和电子显微镜检查显示角膜消融区和未消融区有明显区别。
本研究支持以下假设：一旦切除或消融DL，就无法创建BB。这进一步证明了DL是独特的。它还表明DL不是角膜深层基质的随机分离。
