Surgical Management of Healed Hydrops: A Novel Modification of Deep Anterior Lamellar Keratoplasty

Purpose: The purpose of this case series was to evaluate the effectiveness of modified deep anterior lamellar keratoplasty in eyes with scarring secondary to hydrops associated with keratoconus. Methods: Four patients underwent modified deep anterior lamellar keratoplasty. This was performed by controlled air injection and layer-by-layer dissection of the corneal stroma. The corneal stroma was dissected up to 95% thickness using a Beaver blade. The host Descemet membrane (DM) (4 mm in diameter) that was incorporated in the scar was excised. The DM and the endothelium from the donor button were removed, and the graft was applied to the recipient bed. Twenty percentage sulfur hexafluoride gas was injected to tamponade the host DM to the donor cornea. The graft was sutured with 10-0 monofilament nylon. An amniotic membrane dressing was applied. Results: The preoperative visual acuity was between counting fingers to 6/36. Six weeks postoperatively, the grafts were clear. At 1-year follow-up, the best-corrected visual acuity was 6/12 or better in all patients. Conclusion: Modification of deep anterior lamellar keratoplasty may be an effective alternative to penetrating keratoplasty in eyes with corneal scarring because of previous hydrops.