ESCRS - PP14.03 - Deep Anterior Lamellar Keratoplasty After Healed Corneal Hydrops In Keratoconus: Visual Outcomes And Factors Associated With Surgical Complexity

Deep Anterior Lamellar Keratoplasty After Healed Corneal Hydrops In Keratoconus: Visual Outcomes And Factors Associated With Surgical Complexity

Published 2026 - 44th Congress of the ESCRS

Reference: PP14.03 | Type: Free paper | DOI: 10.82333/n2b3-2r32

Authors: Dr Rafah Fairaq* 1 , Dr Halah Bin Helayel 1 , Dr Omar Kirat 1

1Anterior Segment Division,King Khaled Eye Specialist Hospital & Research Center,Riyadh,Saudi Arabia

Purpose

Corneal hydrops is a severe complication of advanced keratoconus, often leading to penetrating keratoplasty (PKP). This study evaluates visual, refractive, and anatomical outcomes of Deep Anterior Lamellar Keratoplasty (DALK) after healed hydrops and identifies preoperative factors associated with surgical complexity and graft clarity.

Setting

Tertiary referral eye center, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

Methods

Retrospective interventional case series of keratoconic eyes with documented healed hydrops undergoing DALK. Sixteen eyes met inclusion criteria. Preoperative variables included scar location, scar density, and interval from hydrops resolution to surgery. Primary outcomes were intraoperative Descemet’s membrane perforation and conversion to PKP. Secondary outcomes included best-corrected visual acuity (BCVA), graft clarity, rejection, graft failure, and refractive parameters. Associations between scar characteristics and surgical outcomes were analyzed.

Results

Sixteen eyes were included. Preoperative Kmax was 75.9 D and Kmean 63.2 D; postoperative Kmean improved to 53.7 D. Mean BCVA improved from 0.74 ± 0.30 LogMAR preoperatively to 0.38 ± 0.17 LogMAR postoperatively (gain 0.36 LogMAR). Mean interval from hydrops resolution to surgery was 39.8 months. Intraoperative microperforation occurred in 2 eyes (12.5%), both with dense central scars; none required PKP conversion. Rebubbling was needed in 1 eye (6.3%). At final follow-up, 10 grafts (62.5%) were clear; 6 (37.5%) showed mild interface haze, predominantly in central scars. Graft rejection occurred in 2 eyes (12.5%). Mean postoperative cylinder was −4.08 D; mean final spherical equivalent was −3.3 D.

Conclusions

DALK after healed corneal hydrops provides significant visual improvement while preserving host endothelium and avoiding PKP. Dense central scarring increases intraoperative complexity and risk of residual interface haze. In a tertiary referral setting, DALK is an effective endothelial-sparing alternative to traditional full-thickness keratoplasty in post-hydrops keratoconus, with low complication rates and no PKP conversions.