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Peripheral Pneumatic Dissection and Scar Peeling to Complete Deep Anterior Lamellar Keratoplasty in Eyes With Healed Hydrops

Goweida, Mohamed Bahgat, FRCOphth, FRCS(Glasg), PhD*,†,‡; Sobhy, Mohamed, FRCOpth, FRCSEd*; Seifelnasr, Mohamed, MRCSEd*; Liu, Christopher, OBE, FRCOphth, FRCSEd, FRCP†,§,‡

doi: 10.1097/ICO.0000000000001864

Purpose: To describe a surgical technique to achieve the desired plane during deep anterior lamellar keratoplasty (DALK) in eyes with Descemet membrane (DM) tears due to previous hydrops.

Methods: This was a prospective, consecutive, interventional case series of DALK in 12 keratoconic eyes with healed hydrops. Dissection of the peripheral cornea was performed by air injection and using the microbubble incision technique as a guide to the clear predescemetic stroma. The central posterior scar was then removed by peeling to bare DM.

Results: DALK was successfully completed in all eyes, with DM tears ranging from a microperforation to approximately 4 mm. At 12 months, the mean logMAR best-corrected visual acuity was 0.38 ± 0.07, the mean keratometric astigmatism was 5.2 ± 1.9 diopters, and the mean endothelial cell density was 2364 ± 316.9 cells/mm2.

Conclusions: Peripheral pneumatic dissection and central scar peeling technique is a useful technique to complete DALK in eyes with scars due to previous hydrops.

*Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt;

Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom;

Brighton and Sussex Medical School, Brighton, United Kingdom; and

§Tongdean Eye Clinic, Hove, United Kingdom.

Correspondence: Mohamed Bahgat Goweida, FRCOphth, FRCS(Glasg), PhD, Department of Ophthalmology, Faculty of Medicine, Alexandria University, El-Khartoum Square, Azarita Medical Campus, Alexandria, Egypt (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received May 28, 2018

Received in revised form November 28, 2018

Accepted November 29, 2018

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