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

Abstract

Modification of deep anterior lamellar keratoplasty may be an effective alternative to penetrating keratoplasty in eyes with corneal scarring because of previous hydrops.

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

“…A case report by Das et al 8 described BSCVA of 20/20 at 14 months postoperatively. Ramamurthi and Ramaesh9 reported on four cases using a modified DALK technique whereby the hydrops scar and adjoining Descemet's membrane was removed. To avoid a double anterior chamber, Ramamurthi and Ramaesh9 used 20% Sulfahexafluoride gas to tamponade the perforated area and ensuring peripheral attachment.…”

Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus

“…In the advanced stage of keratoconus, as the DM is not involved, either DALK or PK can be used, but for the complication stage, PK may be the only option since tearing of the DM and scarring have occurred in the recipient cornea. However, some investigators have tried DALK in a small series of cases by retaining small amounts of the recipient stroma not reaching the DM for treating keratoconus after acute hydrops (Anwar and Anwar, 2011;Chew et al, 2011;Ramamurthi and Ramaesh, 2011).…”

Long-term Outcomes of Penetrating Keratoplasty for Keratoconus With Resolved Corneal Hydrops

“…[24][25][26] Interestingly, the authors cited an increased risk of allograft rejection/ failure as the main reason for choosing DALK over PK. [24][25][26] However, performing DALK in eyes with resolved hydrops is technically challenging. As shown by our histopathologic data, the area of the DM break is lined by an extremely thin basement membrane, which is likely to give way easily, especially if a big-bubble is attempted.…”