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.

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 μ m (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.

Citation

Dua, H. S., Freitas, R., Mohammed, I., Ting, D. S., & Said, D. G. (2023). 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. Progress in Retinal and Eye Research, 97, Article 101161. https://doi.org/10.1016/j.preteyeres.2022.101161

• Journal Article Type: Review
• Acceptance Date: Dec 28, 2022
• Online Publication Date: Jan 14, 2023
• Publication Date: 2023-11
• Deposit Date: May 15, 2024
• Publicly Available Date: May 15, 2024
• Journal: Progress in Retinal and Eye Research
• Print ISSN: 1350-9462
• Electronic ISSN: 1873-1635
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 97
• Article Number: 101161
• DOI: https://doi.org/10.1016/j.preteyeres.2022.101161
• Keywords: Pre-Descemet's layer, Dua's Layer, Deep anterior lamellar keratoplasty, Acute corneal hydrops,
• Public URL: https://nottingham-repository.worktribe.com/output/15938491
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1350946222001215