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Primary Modified Predescemetic Deep Anterior Lamellar Keratoplasty in Acute Corneal Hydrops

Purpose: To report primary treatment of acute corneal hydrops (CH) with a modified technique of predescemetic deep anterior lamellar keratoplasty (pdDALK). Methods: This prospective interventional case series included 9 eyes with acute CH that underwent pdDALK as primary treatment. Technique modifications included a bevel-up needle, creating tissue emphysema as a guide for dissection, using small aliquots of air directed away from break, manual deeper dissection using a blunt dissector, centripetal dissection leaving the area of Descemet membrane (DM) break for last, retention of minimal stroma above DM tear, and tamponade of DM tear with air in the anterior chamber. In eyes with extensive area of edema or thin residual stroma, an inked trephine mark was manually deepened with a sharp crescent blade, followed by other modifications. Results: All patients underwent uneventful surgery without enlargement of DM tear. The average follow-up period was 18 ± 13 months. All showed a clear, nonedematous graft with an area of DM defect seen and overlying cornea continuing to remain clear at final postoperative follow-up. ASOCT showed 90.8 ± 32 &mgr;m residual predescemetic host stroma on either side of the defect. CDVA improved from 0.002 ± 0.005 preoperatively to 0.35 ± 0.1 by an average of 2.3 ± 0.8 weeks and to 0.52 ± 0.13 at final postoperative follow-up. Conclusions: Primary pdDALK was possible as single-stage definitive treatment with early visual rehabilitation and avoidance of scarring in our case series. Simultaneous correction of pathology by closure of DM break, anatomical correction of ectasia and thinning, optical correction by improved corneal topography and by regaining corneal structure and transparency, and retention of host DM and endothelium are advantages. Advanced DALK surgeons may use this technique.