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Article ; Online: Relationship of posterior peripheral corneal layers and the trabecular meshwork: an immunohistological and anatomical study.

Kepez Yildiz, Burçin / Freitas, Rui / Filippini, Perla / Habroosh, Fatima / Said, Dalia G / Dua, Harminder Singh / Sahay, Prity

The British journal of ophthalmology

2024

Abstract: Background/aim: With the popularity of endothelial keratoplasty (EK) procedures, Descemet membrane (DM) EK and pre-Descemet EK, considerable work has been done on understanding the posterior corneal anatomy. Most of the information available relates to ... ...

Abstract	Background/aim: With the popularity of endothelial keratoplasty (EK) procedures, Descemet membrane (DM) EK and pre-Descemet EK, considerable work has been done on understanding the posterior corneal anatomy. Most of the information available relates to the central cornea. We evaluated the peripheral cornea to explore the immunohistological and anatomical relationship between the pre-Descemet layer (PDL), DM and trabecular meshwork (TM). Methods: Six donor human sclerocorneal discs were studied. PDL, DM and TM were examined by light microscopy, transmission electron microscopy (TEM) and immunohistology. The DM was peeled from the centre to the limit of its peripheral attachment, to reach the transition zone (TZ) between TM and peripheral cornea. Ten-micron sections were stained with antibodies against collagens 1, 2, 3, 4, 5, 6, 12, elastin, myocilin, wnt-1, aquaporin, tenascin C, laminin and integrin alpha 3. Results: Collagens 2, 3, 4, laminin and myocilin were predominantly seen in the TZ between TM and peripheral cornea. Wnt-1, integrin alpha 3 and tenascin C were highly concentrated in TM. Collagen 1 was present predominantly in the corneal stroma. On TEM; DM was thinner with a denser banded structure spread throughout its thickness in the periphery compared with the central cornea where it presents as the distinct anterior banded layer. Conclusion: The TZ between DM, PDL and TM shows a unique histological structure at the periphery. The collagen and elastin fibres of the TM are continuous with the PDL. The structures are firmly attached to each other. These findings provide structural information that is relevant to the preparation of DMEK donor tissue.
Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Journal Article
ZDB-ID	80078-8
ISSN	1468-2079 ; 0007-1161
ISSN (online)	1468-2079
ISSN	0007-1161
DOI	10.1136/bjo-2023-324844
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Article ; Online: Chemical burns acid or alkali, what's the difference?

Said, Dalia G / Dua, Harminder S

Eye (London, England)

2019 Volume 34, Issue 8, Page(s) 1299–1300

MeSH term(s)	Alkalies/adverse effects ; Burns, Chemical/etiology ; Eye ; Eye Injuries ; Humans ; Hydrogen-Ion Concentration
Chemical Substances	Alkalies
Language	English
Publishing date	2019-12-17
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	91001-6
ISSN	1476-5454 ; 0950-222X
ISSN (online)	1476-5454
ISSN	0950-222X
DOI	10.1038/s41433-019-0735-1
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Article ; Online: March consultation #9.

Harminder, S Dua / Rallis, Konstantinos / Said, Dalia G

Journal of cataract and refractive surgery

2021 Volume 47, Issue 3, Page(s) 423

MeSH term(s)	Cicatrix ; Humans ; Lens Implantation, Intraocular ; Microphthalmos ; Referral and Consultation
Language	English
Publishing date	2021-04-26
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	632744-8
ISSN	1873-4502 ; 0886-3350
ISSN (online)	1873-4502
ISSN	0886-3350
DOI	10.1097/01.j.jcrs.0000737840.62123.9f
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Article ; Online: 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.

Dua, Harminder S / Freitas, Rui / Mohammed, Imran / Ting, Darren S J / Said, Dalia G

Progress in retinal and eye research

2023 Volume 97, Page(s) 101161

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Humans ; Descemet Membrane/surgery ; Keratoconus/diagnosis ; Elastin ; Corneal Transplantation/methods ; Edema/surgery ; Glaucoma/surgery
Chemical Substances	Elastin (9007-58-3)
Language	English
Publishing date	2023-01-14
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1182683-6
ISSN	1873-1635 ; 1350-9462
ISSN (online)	1873-1635
ISSN	1350-9462
DOI	10.1016/j.preteyeres.2022.101161
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Article ; Online: Delayed Recovery of Corneal Nerve Function and Structure Following Acoustic Neuroma Surgery.

Al-Aqaba, Mouhamed / Said, Dalia G / Dua, Harminder S

JAMA ophthalmology

2020 Volume 138, Issue 12, Page(s) 1320–1322

MeSH term(s)	Adult ; Blinking/physiology ; Cornea/innervation ; Female ; Humans ; Microscopy, Confocal ; Monitoring, Intraoperative/methods ; Neuroma, Acoustic/surgery ; Otologic Surgical Procedures/adverse effects ; Postoperative Complications/physiopathology ; Recovery of Function
Language	English
Publishing date	2020-10-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2701705-9
ISSN	2168-6173 ; 2168-6165
ISSN (online)	2168-6173
ISSN	2168-6165
DOI	10.1001/jamaophthalmol.2020.4279
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Article ; Online: Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis.

Ting, Darren Shu Jeng / Henein, Christin / Said, Dalia G / Dua, Harminder S

Scientific reports

2021 Volume 11, Issue 1, Page(s) 13007

Abstract: Infectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. ... ...

Abstract	Infectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. This systematic review aimed to examine the effectiveness and safety of adjuvant amniotic membrane transplantation (AMT) for treating IK. Electronic databases, including MEDLINE, EMBASE and Cochrane Central, were searched for relevant articles. All clinical studies, including randomized controlled trials (RCTs), non-randomized controlled studies and case series (n > 5), were included. Primary outcome measure was time to complete corneal healing and secondary outcome measures included corrected-distance-visual-acuity (CDVA), uncorrected-distance-visual-acuity (UDVA), corneal vascularization and adverse events. A total of twenty-eight studies (including four RCTs) with 861 eyes were included. When compared to standard antimicrobial treatment alone, adjuvant AMT resulted in shorter mean time to complete corneal healing (- 4.08 days; 95% CI - 6.27 to - 1.88; p < 0.001) and better UDVA (- 0.26 logMAR; - 0.50 to - 0.02; p = 0.04) at 1 month follow-up in moderate-to-severe bacterial and fungal keratitis, with no significant difference in the risk of adverse events (risk ratio 0.80; 0.46-1.38; p = 0.42). One RCT demonstrated that adjuvant AMT resulted in better CDVA and less corneal vascularization at 6 months follow-up (both p < 0.001). None of the RCTs examined the use of adjuvant AMT in herpetic or Acanthamoeba keratitis, though the benefit was supported by a number of case series. In conclusion, AMT serves as a useful adjuvant therapy in improving corneal healing and visual outcome in bacterial and fungal keratitis (low-quality evidence). Further adequately powered, high-quality RCTs are required to ascertain its therapeutic potential, particularly for herpetic and Acanthamoeba keratitis. Future standardization of the core outcome set in IK-related trials would be invaluable.
MeSH term(s)	Amnion/transplantation ; Animals ; Disease Management ; Disease Susceptibility ; Humans ; Keratitis/etiology ; Keratitis/therapy ; Randomized Controlled Trials as Topic ; Treatment Outcome
Language	English
Publishing date	2021-06-21
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-92366-x
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Article ; Online: Comment on: The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment.

Ting, Darren Shu Jeng / Krause, Sherine / Said, Dalia G / Dua, Harminder S

American journal of ophthalmology

2021 Volume 230, Page(s) 303–304

MeSH term(s)	COVID-19 ; Humans ; SARS-CoV-2 ; Vision, Low
Language	English
Publishing date	2021-05-11
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80030-2
ISSN	1879-1891 ; 0002-9394
ISSN (online)	1879-1891
ISSN	0002-9394
DOI	10.1016/j.ajo.2021.04.036
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Article ; Online: Ex vivo demonstration of canine corneal pre-Descemet's anatomy using pneumodissection as for the big bubble technique for deep anterior lamellar keratoplasty.

Kafarnik, Christiane / Faraj, Lana A / Ting, Darren S J / Goh, Jia Ni / Said, Dalia G / Dua, Harminder S

Scientific reports

2023 Volume 13, Issue 1, Page(s) 5922

Abstract: The recent discovery and characterization of pre-Descemet's layer (PDL; also termed the Dua's layer or the Dua-Fine layer) has advanced the understanding of various posterior corneal pathologies and surgeries in human. This study aimed to characterize ... ...

Abstract	The recent discovery and characterization of pre-Descemet's layer (PDL; also termed the Dua's layer or the Dua-Fine layer) has advanced the understanding of various posterior corneal pathologies and surgeries in human. This study aimed to characterize the ultrastructure of the posterior stroma and interfacial zone of Descemet's membrane (DM) in canine eyes. Eighteen canine corneo-scleral discs were included. Intrastromal air injection resulted in the formation of type 1 big bubble (BB) in 73% (n = 11/15) of corneas, with a mean diameter of 11.0 ± 1.3 mm. No type 2 BB was created. Anterior segment optical coherence tomography, histology and transmission electron microscopy confirmed that the wall of BB was composed of DM, in contact with remaining stroma (canine PDL; cPDL). The cPDL was populated with keratocytes, of varying thickness of 16.2 ± 4.2 µm in close apposition to the DM, and composed of collagen bundles arranged in transverse, longitudinal and oblique directions. The interfacial zone, between DM and cPDL, showed fibril extension in all three directions, predominantly longitudinal. Irregular extensions of DM material into cPDL stroma were observed. No long-spaced collagen was detected. In conclusion, there exists a well-defined cleavage plane between the posterior stroma and cPDL, with similar but not identical characteristics as in humans, that is revealed by pneumodissection. This adds to our understanding of the anatomy of the posterior most canine cornea, which will have significant clinical impact on posterior corneal surgery and understanding of corneal pathology in dogs.
MeSH term(s)	Dogs ; Animals ; Humans ; Descemet Membrane/surgery ; Corneal Transplantation/methods ; Tissue Donors ; Cornea/ultrastructure ; Collagen
Chemical Substances	Collagen (9007-34-5)
Language	English
Publishing date	2023-04-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-24438-5
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Article ; Online: A 7-year review of clinical characteristics, predisposing factors and outcomes of post-keratoplasty infectious keratitis: the Nottingham infectious keratitis study.

Ong, Zun Zheng / Wong, Thai Ling / Suresh, Lakshmi / Hammoudeh, Yasmeen / Lister, Michelle / Said, Dalia G / Dua, Harminder S / Ting, Darren S J

Frontiers in cellular and infection microbiology

2023 Volume 13, Page(s) 1250599

Abstract: Background/objectives: Post-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and ...

Abstract	Background/objectives: Post-keratoplasty infectious keratitis (PKIK) is a unique sight-threatening clinical entity which often poses significant therapeutic challenges. This study aimed to examine the clinical presentation, risk factors, management, and clinical outcomes of PKIK. Methods: This was a retrospective study of all patients who presented to the Queen's Medical Centre, Nottingham, with PKIK between September 2015 and August 2022 (a 7-year period). Relevant data on types of keratoplasty, clinical presentations, causative microorganisms, management, and outcome were analyzed. Results: Forty-nine PKIK cases, including four cases of interface infectious keratitis, were identified during the study period. The most common graft indications for PKP, DALK and EK were failed grafts (9, 37.5%), keratoconus (6, 54.5%) and Fuchs endothelial corneal dystrophy (FECD; 8, 57.1%), respectively. Conclusions: PKIK represents an important cause of IK and graft failure. Bullous keratopathy, OSD and suture-related complications are the commonest risk factors, highlighting the potential benefit of prophylactic topical antibiotics (for unhealthy ocular surface) and early suture removal (where possible) in reducing the risk of PKIK. Graft survival may be higher in lamellar keratoplasty following PKIK but larger studies are required to elucidate this observation.
MeSH term(s)	Humans ; Retrospective Studies ; Keratitis/drug therapy ; Keratitis/epidemiology ; Risk Factors ; Eye ; Corneal Transplantation/adverse effects
Language	English
Publishing date	2023-08-30
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2619676-1
ISSN	2235-2988 ; 2235-2988
ISSN (online)	2235-2988
ISSN	2235-2988
DOI	10.3389/fcimb.2023.1250599
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Article ; Online: False positive microbiological results in Acanthamoeba keratitis: the importance of clinico-microbiological correlation.

Wong, Thai Ling / Ong, Zun Zheng / Marelli, Luca / Pennacchi, Arianna / Lister, Michelle / Said, Dalia G / Dua, Harminder S / Ting, Darren S J

Eye (London, England)

2023 Volume 37, Issue 17, Page(s) 3699–3701

MeSH term(s)	Humans ; Acanthamoeba Keratitis/diagnosis ; Cornea ; Acanthamoeba
Language	English
Publishing date	2023-05-13
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	91001-6
ISSN	1476-5454 ; 0950-222X
ISSN (online)	1476-5454
ISSN	0950-222X
DOI	10.1038/s41433-023-02573-1
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