Deep Lamellar Keratoplasty After Resolution of Hydrops in Keratoconus
- 1 April 2011
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Cornea
- Vol. 30 (4), 454-459
- https://doi.org/10.1097/ico.0b013e3181f0b1f3
Abstract
Deep anterior lamellar keratoplasty (DALK) using Anwar's big-bubble technique is contraindicated in cases of previous hydrops because of the risk of Descemet membrane (DM) rupture at the hydrops scar. Improved manual lamellar dissection techniques down to the deepest stromal layers now enable manual DALK surgery for previous hydrops with the possibility of obtaining good vision, as an alternative to conventional penetrating keratoplasty. Two retrospective case reports of manual DALK in patients with previous hydrops. A 12-year-old boy, with keratoconus and resolved hydrops in his left eye with deep stromal scarring, underwent bilateral manual DALK without baring of the DM. An intraoperative microperforation occurred in his left eye and was managed by intracameral injection of air to seal the perforation. Eleven months after his right DALK and 10 months after his left DALK, his right best spectacle-corrected visual acuity (BSCVA) was 20/20, and his left BSCVA was 20/25. The right cornea was clear, whereas the left cornea had minimal residual deep stromal scarring. Endothelial cell count by specular microscopy was 2611 cells per square millimeter in the right eye and 2193 cells per square millimeter in the left eye. A 28-year-old man, with keratoconus and resolved hydrops in his right eye with deep stromal scarring, underwent right manual DALK without baring of the DM. Nine months postoperatively, his right BSCVA was 20/30, and the graft was clear. Endothelial cell count by specular microscopy was 3148 cells per square millimeter in the right eye. DALK can be performed in patients with previous hydrops. A controlled deep manual dissection technique without baring the DM is advocated. Good final BSCVA can be achieved despite leaving a thin residual layer of the stroma unexcised.Keywords
This publication has 21 references indexed in Scilit:
- Comparison of Outcomes of Lamellar Keratoplasty and Penetrating Keratoplasty in KeratoconusAmerican Journal of Ophthalmology, 2009
- Comparison of Three Different Techniques of Corneal Transplantation for KeratoconusAmerican Journal of Ophthalmology, 2008
- Extended Long-term Outcomes of Penetrating Keratoplasty for KeratoconusOphthalmology, 2006
- Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconusOphthalmology, 2004
- Endothelial cell density after deep anterior lamellar keratoplasty (Melles technique)American Journal of Ophthalmology, 2004
- Deep Lamellar KeratoplastyCornea, 2002
- Penetrating keratoplasty for keratoconus: visual outcome and successOphthalmology, 2000
- Ten-year postoperative results of penetrating keratoplastyOphthalmology, 1998
- Acute Corneal Hydrops in KeratoconusOphthalmology, 1994
- Keratoconus and related noninflammatory corneal thinning disordersSurvey of Ophthalmology, 1984