Clinico-pathological correlation of pre- descemet{u2019}s stromal layer (dua{u2019}s layer) in relation to corneal diseases and corneal surgery / Mohamed Beshr Kenawy ; Supervised Harminder Dua , Tarek Abdelmageed Katamish , Mohamed Hassaballa

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Ophthalmology

Purpose: To determine the role of a novel layer, pre-descemet{u2019}s layer (Dua{u2019}s layer) in posterior corneal pathology and corneal surgery. To study the characteristics of this new layer and to compare it with the rest of the stroma in terms of histology and biomechanical properties, namely scrolling and elasticity. To determine how does air travel through the cornea to create different types of bubbles. Design: Clinical and experimental lab based study. Methods: Clinical: A-cases with posterior corneal pathology were reviewed in highlight of the new layer. B-patients with endothelial dysfunction underwent endothelial keratoplasty with a new surgical technique. Experimental: The pre-descemet{u2019}s layer was isolated from eye bank eyes and its scrolling and elasticity were studied. Density of keratocytes in the posterior stroma and in the layer were analysed in fresh corneas. Air was injected in sclero-corneal discs and intrastromal passage of air was recorded. Results: There was clear evidence that the layer had a role in posterior corneal diseases such as hydrops and posterior corneal surgery. The layer had distinct histological and physical properties than the rest of the stroma. Conclusion: There exists a tough layer in the posterior stroma, with different properties than the rest of the stroma. This layer has clinical application to posterior stromal diseases, as well as an important role in posterior corneal surgery

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