Abstract
Purpose
To define optical coherence tomography (OCT) characteristics of type-1, type-2, and mixed big bubbles (BB) seen in deep anterior lamellar keratoplasty.
Methods
Human sclero-corneal discs were obtained from UK (30) and Canada (16) eye banks. Air was injected into corneal stroma until a BB formed. UK samples were fixed in formalin before scanning with Fourier-domain (FD-OCT). One pair of each type of BB was scanned fresh. All BB obtained from Canada were scanned fresh with time-domain (TD-OCT). For each OCT machine used, type-1 BB from which Descemets membrane (DM) was partially peeled, were also scanned. The morphological characteristics of the scans were studied.
Results
FD-OCT of the posterior wall of type-1 (Dua’s layer (DL) with DM) and type-2 BB (DM alone) both revealed a double-contour hyper-reflective curvilinear image with a hypo-reflective zone in between. The anterior line of type-2 BB was thinner than that seen with type-1 BB. In mixed BB, FD-OCT showed two separate curvilinear images. The anterior image was a single hyper-reflective line (DL), whereas the posterior image, representing the posterior wall of type-2 BB (DM) was made of two hyper-reflective lines with a dark space in between. TD-OCT images were similar with less defined component lines, but the entire extent of the BB could be visualised.
Conclusion
On OCT examination the DM and DL present distinct features, which can help identify type-1, type-2, and mixed BB. These characteristics will help corneal surgeons interpret intraoperative OCT during lamellar corneal surgery.
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References
Anwar M, Teichmann KD . Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty. J Cataract Refract Surg 2002; 28: 398–403.
Dua HS, Faraj LA, Said DG, Gray T, Lowe J . Human corneal anatomy redefined: a novel pre-Descemet's layer (Dua's layer). Ophthalmology 2013; 120: 1778–1785.
Dua HS, Faraj LA, Said DG . Dua’s layer: its discovery, characteristics and clinical applications. In: del Buey A, Sayas MA et al. Biomechanica y Arquitetura Corneal. Elsevier: Barcelona, 2014, pp 35–47.
Dua HS, Katamish T, Said DG, Faraj LA . Differentiating type 1 from type 2 big bubbles in deep anterior lamellar keratoplasty. Clin Ophthalmol 2015; 9: 1155–1157.
Lim SH . Clinical applications of anterior segment optical coherence tomography. J Ophthalmol 2015; 2015: 605729.
Ramos JL, Li Y, Huang D . Clinical and research applications of anterior segment optical coherence tomography - a review. Clin Experiment Ophthalmol 2009; 37: 81–89.
Fujimoto JG, Huang D . Introduction to optical coherence tomography. In: Huang D, Duker JS et al. Imaging the Eye from Front to Back with RTVue Fourier-Domain Optical Coherence Tomography. SLACK Inc.: New Jersey, USA, 2010, pp 1–22.
Izatt JA, Hee MR, Swanson EA, Lin CP, Huang D, Schuman JS et al. Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography. Arch Ophthalmol 1994; 112: 1584–1589.
Wylegala E, Teper S, Nowinska AK, Milka M, Dobrowolski D . Anterior segment imaging: Fourier-domain optical coherence tomography versus time-domain optical coherence tomography. J Cataract Refract Surg 2009; 35: 1410–1414.
Sharma N, Gupta S, Maharana P, Shanmugam P, Nagpal R, Vajpayee RB . Anterior segment optical coherence tomography-guided management algorithm for descemet membrane detachment after intraocular surgery. Cornea 2015; 34: 1170–1174.
Rocha G . Use of the visante for anterior segment ocular coherence tomography. Tech Ophthalmol 2007; 5: 67–77.
Dada T, Sihota R, Gadia R, Aggarwal A, Mandal S, Gupta V . Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment. J Cataract Refract Surg 2007; 33: 837–840.
Wang C, Xia X, Tian B, Zhou S . Comparison of fourier-domain and time-domain optical coherence tomography in the measurement of thinnest corneal thickness in keratoconus. J Ophthalmol 2015; 2015: 402925.
Leitgeb R, Hitzenberger C, Fercher A . Performance of fourier domain vs. time domain optical coherence tomography. Opt Express 2003; 11: 889–894.
Altaan SL, Gupta A, Sidney LE, Elalfy MS, Agarwal A, Dua HS . Endothelial cell loss following tissue harvesting by pneumodissection for endothelial keratoplasty: an ex vivo study. Br J Ophthalmol 2015; 99: 710–713.
Dua HS, Faraj L, Said DG . Dua’s layer: discovery, characteristics, clinical applications, controversy and potential relevance to glaucoma. Expert Rev Ophthalmol 2015; 10: 531–547.
Shousha MA, Perez VL, Wang J, Ide T, Jiao S, Chen Q et al. Use of ultra-high-resolution optical coherence tomography to detect in vivo characteristics of Descemet's membrane in Fuchs' dystrophy. Ophthalmology 2010; 117: 1220–1227.
Christopoulos V, Kagemann L, Wollstein G, Ishikawa H, Gabriele ML, Wojtkowski M et al. In vivo corneal high-speed, ultra high-resolution optical coherence tomography. Arch Ophthalmol 2007; 125: 1027–1035.
Ferre LA, Nada O, Sherknies D, Boisjoly H, Brunette I . Optical coherence tomography anatomy of the corneal endothelial transplantation wound. Cornea 2010; 29: 737–744.
Mencucci R, Favuzza E, Tartaro R, Busin M, Virgili G . Descemet stripping automated endothelial keratoplasty in Fuchs' corneal endothelial dystrophy: anterior segment optical coherence tomography and in vivo confocal microscopy analysis. BMC Ophthalmol 2015; 15: 99.
Huang D, Li Y, Tang M . Interpretation of corneal images. In: Huang D, Duker SJ et al. Imaging the Eye from Front to Back with RTVue Fourier-Domain Optical Coherence Tomography. SLACK Inc.: New Jersey, USA, 2010, pp 39–46.
Siebelmann S, Hermann M, Dietlein T, Bachmann B, Steven P, Cursiefen C . Intraoperative optical coherence tomography in children with anterior segment anomalies. Ophthalmology 2015; 122: 2582–2584.
Ide T, Wang J, Tao A, Leng T, Kymionis GD, O'Brien TP et al. Intraoperative use of three-dimensional spectral-domain optical coherence tomography. Ophthalmic Surg Lasers Imaging 2010; 41: 250–254.
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We would like to thank the Elizabeth C King Trust for the financial support.
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AlTaan, S., Termote, K., Elalfy, M. et al. Optical coherence tomography characteristics of different types of big bubbles seen in deep anterior lamellar keratoplasty by the big bubble technique. Eye 30, 1509–1516 (2016). https://doi.org/10.1038/eye.2016.129
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DOI: https://doi.org/10.1038/eye.2016.129
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