前descemet层(Dua's层,也称为Dua- fine层和前后限制性板层):发现,特征,临床和手术应用,以及争议。

IF 18.6 1区 医学 Q1 OPHTHALMOLOGY Progress in Retinal and Eye Research Pub Date : 2023-11-01 DOI:10.1016/j.preteyeres.2022.101161
Harminder S. Dua , Rui Freitas , Imran Mohammed , Darren S.J. Ting , Dalia G. Said
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引用次数: 6

摘要

后弹力前层/Dua层,也称为Dua-Fine层和前-后界薄层,位于角膜后弹力膜的前面,厚度为10μm(范围6-16),主要由I型和一些VI型胶原组成,具有丰富的弹性蛋白,比角膜的任何其他层都多。它具有高拉伸强度(爆裂压力高达700毫米汞柱),不透气,几乎无细胞。在外围,它显示出开窗和分支,成为小梁网的核心,对眼压和青光眼有影响。它已在某些动物身上得到证实。该层在前板层和后板层角膜移植手术中具有相当重要的意义,因为它提高了我们对角膜组织在这些手术中的行为的理解,改进了技术,使手术更安全,效果更好。它导致了新的手术程序的创新,即Descemet前的内皮角膜移植术、急性积水的缝合管理、DALK三联和Fogla的迷你DALK。该层的发现和知识引入了我们对后弹力层膜脱离、圆锥角膜和后弹力层急性角膜积水等古老概念的范式转变,并对管理方法产生了影响。它已被证明有助于在角膜感染和一些角膜营养不良中观察到的病理学和临床症状。早期证据表明,与其弹性蛋白含量有关,它可能在圆锥角膜的发病机制中发挥作用。它对角膜生物力学和青光眼的贡献是目前研究的主题。
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The pre-Descemet's layer (Dua's layer, also known as the Dua-Fine layer and the pre-posterior limiting lamina layer): Discovery, characterisation, clinical and surgical applications, and the controversy

The pre-Descemet's layer/Dua's layer, also termed the Dua-Fine layer and the pre-posterior limiting lamina layer, lies anterior to the Descemet's membrane in the cornea, is 10 μm (range 6–16) thick, made predominantly of type I and some type VI collagen with abundant elastin, more than any other layer of the cornea. It has high tensile strength (bursting pressure up to 700 mm of Hg), is impervious to air and almost acellular. At the periphery it demonstrates fenestrations and ramifies to become the core of the trabecular meshwork, with implications for intraocular pressure and glaucoma. It has been demonstrated in some species of animals.

The layer has assumed considerable importance in anterior and posterior lamellar corneal transplant surgery by improving our understanding of the behaviour of corneal tissue during these procedures, improved techniques and made the surgery safer with better outcomes. It has led to the innovation of new surgical procedures namely, pre-Descemet's endothelial keratoplasty, suture management of acute hydrops, DALK-triple and Fogla's mini DALK.

The discovery and knowledge of the layer has introduced paradigm shifts in our age old concepts of Descemet's membrane detachment, acute corneal hydrops in keratoconus and Descemetoceles, with impact on management approaches. It has been shown to contribute to the pathology and clinical signs observed in corneal infections and some corneal dystrophies. Early evidence suggests that it may have a role in the pathogenesis of keratoconus in relation to its elastin content. Its contribution to corneal biomechanics and glaucoma are subjects of current investigations.

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来源期刊
CiteScore
34.10
自引率
5.10%
发文量
78
期刊介绍: Progress in Retinal and Eye Research is a Reviews-only journal. By invitation, leading experts write on basic and clinical aspects of the eye in a style appealing to molecular biologists, neuroscientists and physiologists, as well as to vision researchers and ophthalmologists. The journal covers all aspects of eye research, including topics pertaining to the retina and pigment epithelial layer, cornea, tears, lacrimal glands, aqueous humour, iris, ciliary body, trabeculum, lens, vitreous humour and diseases such as dry-eye, inflammation, keratoconus, corneal dystrophy, glaucoma and cataract.
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