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London, October 1 A team led by a scientist of Indian origin has made an unprecedented discovery that could help improve the success of corneal transplants in patients with diseases.
The research, published in the American Journal of Ophthalmology, has brought to light a feature of the thin membrane called Descemets membrane that can cause difficulties for surgeons performing the complex procedure of Descemets membrane transplantation.
The study was conducted by Harminder Dua, a professor at the University of Nottingham in the United Kingdom, whose team was the first to discover a new layer of the corneal Pre-Descendants layer, also called the Dua layer. .
"This work demonstrated the obvious structural uniqueness of the pre-Descemets layer (Dua layer) and also answered a curious surgical question about why the Descemets membrane rolls in one direction when it is taken off the donor's eye ".
"This understanding will pave the way for developing strategies for rolling it out during transplantation, with minimal damage to cells that it supports," he said.
Descemet's membrane, named after the French doctor who discovered it at the end of the 18th century, lies between the pre-Descemets layer (Dua layer) and the endothelial layer at the end of the 18th century. 39, back of the cornea, responsible for pumping excess fluid and keep the cornea sufficiently dehydrated to maintain a clear vision.
In certain diseases such as Fuchs dystrophy or after cataract surgery, the endothelial cells and Descemet's membrane are damaged, leading to corneal saturation and vision impairment.
Over time, vision deteriorates and, if left untreated, may result in loss of vision.
To remedy this problem, patients can be offered one of several types of corneal grafting, in which all parts of the damaged or different cornea are removed and replaced with healthy tissue from a donor.
In Descemet's membrane endothelial keratoplasty (DMEK), the damaged Descemet's membrane is scraped off and replaced with a Descemet's membrane.
When the membrane is separated from the other layers of the cornea to prepare it for transplantation, it turns into a cigar-shaped roll that facilitates insertion into the cornea through a small incision, but once in place, it is extremely difficult to deploy.
When handling laminated tissue, sensitive endothelial cells that cover the outside of the membrane can be damaged, reducing the success of the transplant.
In the pre-Descemet endothelial keratoplasty (PDEK), the Descemet's membrane is transplanted while it is attached to another layer, the pre-Descemet layer, also known as the Dua layer after its discovery by Dua in 2013 .
It has been found that, even though there is still a rolling, it is not so pronounced, as the pre-Descemets or Dua layer stabilizes the Descemet layer acting as a kind of "wear and tear". splint.
Ophthalmologists have long observed that Descemet's membrane would only roll in one direction, leaving the endothelial cells on the outside of the loop, but wondered why.
Research has shown for the first time that the direction of the roll is governed by the content and distribution of elastin-elastic fibers in the membrane.
Using 31 corneal disks, the researchers measured the elastin content of the Descemet's membrane, the pre-Descemet membrane, the stroma, and other sites of the cornea.
They also examined whether the treatment of Descemet's membrane with an enzyme that digests elastin had any effect on tissue rolling and whether the elimination of endothelial cells had an impact on this behavior .
The researchers found that the pre-Descemet layer had the highest elastin content of all the tissues studied, but that elastin was evenly distributed in the tissues. SAR
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