Outcomes of deep anterior lamellar keratoplasty in keratoconic eyes with previous hydrops

Aim To evaluate outcomes of deep anterior lamellar keratoplasty (DALK) in keratoconic eyes with previous hydrops. Methods In this retrospective, non-comparative study, keratoconic eyes with previous hydrops that underwent DALK were included. DALK was performed using a modification of Melles's technique of optical recognition with pre-Descemet's membrane dissection. Data on preoperative and postoperative uncorrected distance visual acuity and best spectacle corrected distance visual acuity (BSCVA), postoperative spherical equivalent (SEQ); keratometry and adverse events were recorded for all eyes. Results Ten eyes (10 patients) underwent DALK in keratoconic eyes with previous hydrops. Mean follow-up was 56.4 +/- 23.8 months. Preoperatively BSCVA was 6/24 or worse in all eyes. At last follow-up, 100% had BSCVA of 6/12 or better. Intraoperative microperforation at the site of previous hydrops occurred in six eyes but none required conversion to penetrating keratoplasty. At latest follow-up, mean SEQ was -2.4 +/- 4.2D, keratometric astigmatism was 3.8 +/- 1.6D and refractive astigmatism was 3.4 +/- 2.2D. Mean postoperative keratometry was 43.7 +/- 2.6 and central pachymetry 572.6 +/- 65.0 mu m. Conclusions DALK in keratoconic corneas with prior hydrops is a safe and effective option that preserves host endothelium Intraoperative microperforations at the site of hydrops are common, however with good management favourable outcomes are possible.