Lamellar keratoplasty following thermokeratoplasty in the treatment of acute corneal hydrops.

Abstract

PURPOSE:

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

DESIGN:

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.

• Authors: Suxia Li, Mingna Liu, Qin Wang, Ting Wang, Weiyun Shi
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 158 Issue 1 Pg. 26-31.e1 (Jul 2014) ISSN: 1879-1891 [Electronic] United States
• PMID: 24699158 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Acute Disease
• Adolescent
• Adult
• Anterior Chamber (surgery)
• Corneal Edema (diagnosis, etiology, surgery)
• Corneal Topography
• Corneal Transplantation (methods)
• Diathermy (methods)
• Female
• Humans
• Intraoperative Complications
• Keratoconus (complications, diagnosis, surgery)
• Male
• Postoperative Complications
• Retrospective Studies
• Tomography, Optical Coherence
• Visual Acuity (physiology)
• Wound Healing
• Young Adult