Lamellar keratoplasty following thermokeratoplasty in the treatment of acute corneal hydrops.
OBJECTIVE
To observe the efficacy of deep anterior lamellar keratoplasty (DALK) for treatment of acute hydrops in keratoconus after anterior chamber paracentesis combined with thermokeratoplasty.


METHODS
Retrospective, noncomparative clinical case series.


METHODS
Twenty-one patients (21 eyes) suffering acute hydrops associated with keratoconus were treated first by anterior chamber paracentesis combined with thermokeratoplasty. At 1 week after the edema was absorbed, and Descemet membrane ruptures and stromal clefts were cured, all patients received modified DALK. Descemet membrane re-ruptures during surgery were recorded, if any. Graft transparency, visual acuity, recipient folds or opacity, and immune rejection were monitored for 6 months to 1 year.


RESULTS
All the corneal edema alleviated rapidly, and the intrastromal clefts narrowed within 1 week after combined anterior chamber paracentesis and thermokeratoplasty. DALK was performed successfully in all patients within 2 weeks after the first surgical procedure, with no Descemet membrane rebreaking or corneal perforation. The recipients were completely clear in 7 eyes, and mild fusiform scars appeared at the central recipient in 14 eyes. All the opacity of Descemet membrane ruptures became slight or even disappeared after 6 months. The mean best-corrected visual acuity was improved to 20/30 at 1 year after DALK. No immune rejection occurred.


CONCLUSIONS
Anterior chamber paracentesis combined with thermokeratoplasty can accelerate the absorption of corneal edema in patients with acute corneal hydrops (within 1 week) and Descemet membrane rupture healing without obvious opacity (within 2 weeks). During this window phase, DALK could be performed safely, and good visual acuity may be obtained.
Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China.
Suxia
S
Li
Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China.
Mingna
M
Liu
Jinan Central Hospital, Jinan, China.
Qin
Q
Wang
Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China.
Ting
T
Wang
Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China. Electronic address: weiyunshi@163.com.
Weiyun
W
Shi
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000867:Anterior Chamber / Q000601:surgery; D015715:Corneal Edema / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D003972:Diathermy / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007640:Keratoconus / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014945:Wound Healing; D055815:Young Adult