Deep Anterior Lamellar Keratoplasty Following Epikeratophakia: A Novel Two-Stage One-Graft Method To Treat Acute Corneal Hydrops

Purpose To evaluate the clinical effects of deep anterior lamellar keratoplasty (DALK) using a single graft after epikeratophakia for the treatment of acute corneal hydrops. Methods This novel surgical procedure was performed on seven eyes of seven patients between 2019 and 2020. The procedure combines a first-stage surgery of epikeratophakia with intracameral sterile air injection and a second-stage surgery of DALK using the same corneal graft for both procedures. Main outcome measures included pre- and postoperative best-corrected visual acuity (BCVA) and anterior segment optical coherence tomography (AS-OCT) parameters. Corneal transparency, neovascularization and epithelization were observed at the 1-year follow-up. Results Corneal edema resolved rapidly in six of the seven cases. The group mean central corneal thickness was significantly reduced from baseline at 1 day, 1 week, 1 month, and 2 months after the first-stage surgery, respectively (P < 0.0001). At a mean of 2.1±0.7 months after the first-stage surgery, DALK was successfully performed in all cases. Six months later, the central corneal thickness was 611±31 µm and the thickness of the recipient’s residual stroma bed was 20±6 µm at the central corneal area. LogMAR BCVA was improved from 1.74±0.34 at baseline to 0.20±0.11 after DALK (P < 0.0001). No postoperative complications appeared in our case series during one years of observation. Conclusion A novel curative effect was found in the treatment of acute corneal hydrops with epikeratophakia followed by DALK using the same corneal graft.