title: Outcomes of deep anterior lamellar keratoplasty in keratoconic eyes with previous hydrops.
abstract: OBJECTIVE
  To evaluate outcomes of deep anterior lamellar keratoplasty (DALK) in keratoconic eyes with previous hydrops.
  
  
  METHODS
  In this retrospective, non-comparative study, keratoconic eyes with previous hydrops that underwent DALK were included. DALK was performed using a modification of Melles's technique of optical recognition with pre-Descemet's membrane dissection. Data on preoperative and postoperative uncorrected distance visual acuity and best spectacle corrected distance visual acuity (BSCVA), postoperative spherical equivalent (SEQ); keratometry and adverse events were recorded for all eyes.
  
  
  RESULTS
  Ten eyes (10 patients) underwent DALK in keratoconic eyes with previous hydrops. Mean follow-up was 56.4 ± 23.8 months. Preoperatively BSCVA was 6/24 or worse in all eyes. At last follow-up, 100% had BSCVA of 6/12 or better. Intraoperative microperforation at the site of previous hydrops occurred in six eyes but none required conversion to penetrating keratoplasty. At latest follow-up, mean SEQ was -2.4 ± 4.2D, keratometric astigmatism was 3.8 ± 1.6D and refractive astigmatism was 3.4 ± 2.2D. Mean postoperative keratometry was 43.7 ± 2.6 and central pachymetry 572.6 ± 65.0 µm.
  
  
  CONCLUSIONS
  DALK in keratoconic corneas with prior hydrops is a safe and effective option that preserves host endothelium Intraoperative microperforations at the site of hydrops are common, however with good management favourable outcomes are possible.
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: Mayank A
authors.initials: MA
authors.lastname: Nanavaty
authors.forename: Sheraz M
authors.initials: SM
authors.lastname: Daya
mesh_terms: D000328:Adult; D015715:Corneal Edema / Q000473:pathology* / Q000601:surgery*; D057112:Corneal Perforation / Q000473:pathology / Q000601:surgery; D016039:Corneal Transplantation / Q000379:methods*; D003886:Descemet Membrane / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007640:Keratoconus / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult