title: Histopathology and spectral domain OCT findings of pneumatic-assisted dissection in DALK.
abstract: OBJECTIVE
  To correlate big-bubble deep anterior lamellar keratoplasty findings in donor corneas with anterior segment optical coherence tomography (OCT) and histology.
  
  
  METHODS
  This research was conducted entirely at the University of Texas Southwestern Medical Center in Dallas, Texas. We performed deep intrastromal air injections in donor corneas on artificial chambers. Surgical patterns (big bubble, intrastromal emphysema, and perforation) were assessed by spectral domain OCT with a handheld probe and histology.
  
  
  RESULTS
  Surgical patterns were evaluated by histology using a novel embedding technique. A classic big bubble may be a Descemet membrane (DM) detachment with a few attached stromal fibrils. There were no large intra-DM separations as previously reported. The emphysematous surgical patterns result from intrastromal emphysema, which can be accompanied by microdetachments of DM. We saw indirect OCT signs of big bubble, but scatter from intrastromal emphysema limits deeper imaging.
  
  
  CONCLUSIONS
  Surgical patterns of big bubble and intrastromal emphysema correlate with characteristic histology findings. Marked scatter on OCT by intrastromal emphysema limits visualization of deeper corneal structures, but the presence of a big bubble may be inferred.
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9057, USA.
authors.forename: Soo Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Orkun
authors.initials: O
authors.lastname: Muftuoglu
authors.forename: R Nick
authors.initials: RN
authors.lastname: Hogan
authors.forename: R Wayne
authors.initials: RW
authors.lastname: Bowman
authors.forename: H Dwight
authors.initials: HD
authors.lastname: Cavanagh
authors.forename: James P
authors.initials: JP
authors.lastname: McCulley
authors.forename: V Vinod
authors.initials: VV
authors.lastname: Mootha
mesh_terms: D000388:Air; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000473:pathology*; D016039:Corneal Transplantation; D003886:Descemet Membrane / Q000473:pathology; D004646:Emphysema / Q000175:diagnosis*; D006801:Humans; D007267:Injections; D012421:Rupture; D014019:Tissue Donors; D041623:Tomography, Optical Coherence