Wet-Peeling Technique of Deep Anterior Lamellar Keratoplasty With Hypotonic Water and Blunt Dissection for Healed Hydrops

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To describe the surgical technique and outcomes of “wet-peeling” deep anterior lamellar keratoplasty (DALK) using sterile water and blunt dissection in cases with corneal scarring after healed corneal hydrops.


Manual DALK using a “wet-peeling” technique was performed in 20 eyes of 20 consecutive patients with healed corneal hydrops between June 2011 and October 2013.


Intraoperative microperforations were encountered in 2 (10%) cases. None of the cases required conversion to penetrating keratoplasty. There was significant improvement in mean best-corrected visual acuity at the end of 24 months postoperatively (0.99 ± 0.30 logMAR vs. 0.20 ± 0.11 logMAR; P < 0.001). The postoperative mean residual stromal bed thickness was 48.9 ± 5.9 μm, and mean central corneal thickness was 557.2 ± 50.3 μm. The mean endothelial density was 2021 ± 236 cells/mm2 at the final follow-up.


Manual DALK using sterile water can be successfully performed in corneas with healed hydrops. Favorable visual outcomes may be attributed to thin residual bed thickness postoperatively.

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