Predescemetic Dissection for Healed Hydrops-Judicious Use of Air and Fluid

Purpose: To demonstrate the efficacy of a planned near-Descemet dissection deep anterior lamellar keratoplasty (nddDALK) in posthydrops corneal scarring. Methods: In a retrospective noncomparative case series, nddDALK was performed on 22 consecutive eyes of 22 patients with posthydrops scarring because of keratoconus. After a partial thickness corneal trephination, air was injected at superficial to midstromal depth, followed by an anterior keratectomy. Multiple episodes of stromal hydration with a blunt cannula followed by air injection were repeated to leave a thin stromal layer. A #69 Beaver blade (BD, Franklin Lakes, NJ) was used to remove the scar. The best spectacle-corrected visual acuity (BSCVA), spherical equivalent, and refractive cylinder were recorded 12, 24, and 36 months after surgery. Intraoperative and postoperative complications were noted. Results: Twelve months after surgery, the BSCVA was >= 20/40 in 68.1% of patients. The mean spherical equivalent was -3.53 +/- 2.94 diopters (D), and the average refractive cylinder was 3.42 +/- 1.7 D. Microperforations occurred in 6 patients, all of which were successfully tamponaded by an intracameral air injection alone. Conclusions: nddDALK gives good visual results and quality of vision. In developing countries, lamellar-grade donor corneas are almost the only option available. Apart from visual benefits, the procedure puts the patient at a minimal risk of immune rejection, which is a major complication of penetrating keratoplasty.