Predescemetic dissection for healed hydrops--judicious use of air and fluid

To demonstrate the efficacy of a planned near-Descemet dissection deep anterior lamellar keratoplasty (nddDALK) in posthydrops corneal scarring.

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.

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.

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.