{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T23:47:55Z","timestamp":1790034475227,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,5,8]],"date-time":"2017-05-08T00:00:00Z","timestamp":1494201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000692","name":"Royal College of Surgeons of Edinburgh","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000692","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To examine the movement of air injected in the cornea in simulated deep anterior lamellar keratoplasty (<jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content>), from the needle tip to the formation of different types of big bubbles (<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content>) and to ascertain how air travels through the stroma and pre\u2010Descemet's layer [Dua's layer (<jats:styled-content style=\"fixed-case\">PDL<\/jats:styled-content>)] to create a type\u20101 (air between <jats:styled-content style=\"fixed-case\">PDL<\/jats:styled-content> and deep stroma) and type\u20102<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> (air between <jats:styled-content style=\"fixed-case\">PDL<\/jats:styled-content> and Descemet's membrane).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Air was injected in 57 sclerocorneal discs and the passage recorded. Leaking points and sites of commencement of type\u20101 and type\u20102<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> were examined by scanning electron microscopy. Stromal distribution of air pockets was studied by light microscopy. Uninjected corneas served as controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Injected air followed a consistent pattern, initially as radial tracks to the limbus, then as circumferential bands along the limbus and finally centripetally to create predominantly a type\u20101<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content>. Type\u20102<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> started at the periphery, by air emerging through clusters of tiny fenestrations discovered in the periphery of <jats:styled-content style=\"fixed-case\">PDL<\/jats:styled-content>. Fifteen to 20 such clusters were also seen in control samples on either side of the Descemet's attachment. Type\u20101<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> was formed by air emerging through wide spaces between lamellae of deep stroma. Histologically, the circumferential band revealed an aggregation of air pockets in the mid\u2010stroma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The consistent pattern of passage of air is indicative of the architecture and microanatomy of the corneal stroma where collagen lamellae are orthogonally arranged centrally and as a circular annulus at the periphery. The novel peripheral fenestrations explain the peripheral commencement of a type\u20102<jats:styled-content style=\"fixed-case\">BB<\/jats:styled-content> and the escape of air into the anterior chamber during <jats:styled-content style=\"fixed-case\">DALK<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.13460","type":"journal-article","created":{"date-parts":[[2017,5,8]],"date-time":"2017-05-08T11:26:44Z","timestamp":1494242804000},"page":"69-76","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Dynamics of big bubble formation in deep anterior lamellar keratoplasty by the big bubble technique: <i>in\u00a0vitro<\/i> studies"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4683-6917","authenticated-orcid":false,"given":"Harminder S","family":"Dua","sequence":"first","affiliation":[{"name":"Larry A Donoso Laboratory for eye research Academic Section\u00a0of 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Donoso Laboratory for eye research Academic Section\u00a0of Ophthalmology Division of Clinical Neuroscience University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6796-9340","authenticated-orcid":false,"given":"Mohamed S","family":"Elalfy","sequence":"additional","affiliation":[{"name":"Larry A Donoso Laboratory for eye research Academic Section\u00a0of Ophthalmology Division of Clinical Neuroscience University of Nottingham Nottingham UK"},{"name":"Research Institute of Ophthalmology Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Katamish","sequence":"additional","affiliation":[{"name":"Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia G","family":"Said","sequence":"additional","affiliation":[{"name":"Nottingham University Hospitals NHS Trust Nottingham UK"},{"name":"Research Institute of Ophthalmology Cairo 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