Dua’s layer: discovery, characteristics, clinical applications, controversy and potential relevance to glaucoma

Hydrops after corneal perforation during manual deep anterior lamellar keratoplasty for keratoconus

“…Interestingly, the other four eyes, in which a donor corneal button was sutured in place, showed swelling, displacement and/or disruption of the most posterior corneal stroma left in situ, while the anatomy of the overlying graftalthough swollenappeared normal. Our observation may further support the hypothesis that, apart from a break in the posterior cornea, an abnormal host mid-stroma may be important in hydrops formation (Dua et al 2015), because host tissue showed significant swelling while the donor corneal button did not. Furthermore, since peripheral intraoperative perforations usually seem unaccompanied by significant tissue distortion during and after surgery, the abnormal stromal anatomy may largely be limited to the central cornea and/or the actual 'cone'.…”

“…I n our recently published article 'Are Descemet membrane ruptures the root cause of corneal hydrops in keratoconic eyes?' (Parker et al 2019), we described how hydrops formation in keratoconus (KC) may be subjected to a more complex mechanism than currently hypothesized, that is, a hydrops would result from a break in Descemet membrane (DM) in the background of abnormal collagen of the corneal stroma in KC (Dua et al 2015;White et al 2017;Loh et al 2018;Parker et al 2019). In eyes with Fuchs endothelial corneal dystrophy and coexisting KC, removal of DM during descemetorhexis never resulted in any sign of hydrops formation, while a stromal perforation into the anterior chamber during Bowman layer transplantation consistently produced a significant hydrops (Parker et al 2019).…”

Dynamics of big bubble formation in deep anterior lamellar keratoplasty by the big bubble technique: in vitro studies

“…; Dua et al. ). With pneumo‐dissection, the type‐1BB (cleavage between PDL and stroma) is common but often a type‐2BB (cleavage between DM and PDL) or a mixed BB forms (Dua et al.…”

Age related changes seen in human cornea in formalin fixed sections and on biomicroscopy in living subjects: A comparison

“…DL was characterized by Dua et al and was shown to be strong (Zaki et al, ), demonstrated by its ability to resist a pressure of around 500 mm of mercury (Dua et al, , ). The layer is made of five to eight compact thin lamellae of Type 1 collagen, has an abundance of Type 6 (long spacing) collagen, is devoid or sparsely populated with keratocytes, is impervious to air, is populated by trabecular cells at the peripheral 350 μm, and continues as the collagen core of the trabecular meshwork (Dua et al, , ; Dua and Said, ). The cornea is characterized by important changes with normal aging.…”