MANAGEMENT OF CHRONIC CORNEAL HYDROPS WITH DOUBLE LENTICULE TRANSPLANTATION

 To evaluate the clinical outcomes of double lenticule transplantation in keratoconus patients with chronic corneal hydrops.

Eye Hospital, Prishtina, Kosovo

This study included 24 keratoconus eyes with chronic corneal hydrops after prior crosslinking, indicated for penetrating keratoplasty. The cohort consisted of 24 patients (mean age 21.2 ± 2.5 years; 13 males, 11 females). All underwent double lenticule transplantation with one full lenticule (134.2 ± 18.0 µm, –6.70 ± 0.91 D) and one semi-moon lenticule (149.4 ± 14.6 µm), customized to astigmatism. The lenticules were transplanted through a 3-mm intrastromal pocket created at a depth of 130 µm, with the intended postoperative target of restoring central corneal thickness to approximately 460 µm. All patients completed a minimum follow-up period of 12 months.

At 12 months postoperatively, significant visual and structural improvements were observed. Mean UDVA improved from 1.73 ± 0.24 logMAR preoperatively to 0.76 ± 0.17 logMAR, while CDVA improved from 0.42 ± 0.07 logMAR. Corneal asphericity demonstrated a shift toward a more prolate profile, with the Q-value increasing from –0.75 ± 0.05 to –0.62 ± 0.04. Keratometric values showed flattening, with K1/K2 decreasing from 71.7/61.0 D to 66.8/61.0 D. Central corneal thickness increased markedly from 348.0 ± 20.3 µm to 482.5 ± 8.7 µm, confirming substantial stromal augmentation. No cases of intraoperative or postoperative complications, including immune rejection, were reported throughout the follow-up period.

Double lenticule transplantation utilizing one full lenticule and one semi-moon lenticule represents a promising and less invasive alternative to penetrating keratoplasty for advanced keratoconus with chronic corneal hydrops. This approach achieves substantial stromal reinforcement while preserving corneal clarity, thereby supporting both structural stability and visual rehabilitation.