Deep anterior lamellar keratoplasty using the same graft after epikeratophakia for the treatment of acute corneal hydrops in keratoconus

Objective To evaluate the clinical effects of deep anterior lamellar keratoplasty (DALK) using the same graft after epikeratophakia for the treatment of acute corneal hydrops in keratoconus. Methods A consecutive 7 cases (7 eyes) with acute corneal hydrops in keratoconus in our department were retrospectively analyzed. Same corneal graft was used to perform the first stage epikeratophakia combined with C3F8 anterior chamber injection. About 6 months after the first surgery, the secondary stage deep anterior lamellar keratoplasty combined with air anterior chamber injection was performed. The best corrected visual acuity, healing status of the anterior and posterior corneal surface, anterior segment optical coherence tomography parameters, and corneal endothelial cells density were recorded. Results The central corneal thickness was (1764±256) μm before the treatment, and it was (778±147) μm, (604±23) μm, (579±20) μm and (525±19) μm at the time points of 1 d, 7 d, 1 and 6 months after the first stage surgery respectively. An average (6.1±1.3) months after the first stage surgery, the second stage DALK was performed. The descemet's membrane at the central area could be fully exposed in 3 eyes. Slow liquid exudations in the deep corneal stroma near the descemet's membrane were found in the other 4 eyes during stroma dissection. DALKs were successfully performed in all the 7 cases. Double anterior chambers were found in 2 eyes 1d after DALK. The whole corneal thicknesses were (781±57) μm, (581±49) μm and (521±19) μm at 7 d, 1 and 3 months after DALK respectively. Three months later, the thickness of the receptors' residual stroma bed was (21±11) μm at the central corneal area. At the end of the follow-up, the BCVA(LogMAR)was 0.11±0.03. Conclusion Novel curative effect was found in the treatment of acute corneal hydrops in keratoconus by deep anterior lamellar keratoplasty using the same graft after epikeratophakia. Key words: Acute corneal hydrops, keratoconus; Epikeratophakia; Keratoplasty, deep anterior lamellar; Anterior segment optical coherence tomography; Descemet's membrane