Hydrops In Keratoconus Research Articles

Mini-Scleral Lens: An Effective Mode of Visual Rehabilitation in Eyes With Resolved Hydrops.

To evaluate the visual outcome of mini-scleral contact lenses (MSLs) in keratoconus following the resolution of acute hydrops. This was a prospective observational case series of patients of healed hydrops in keratoconus fitted with an MSL (Keracare, Acculens, Lakewood, CO) who were managed for acute hydrops medically or surgically at least 3 months prior. Uncorrected visual acuity, best spectacles-corrected visual acuity, best lens-corrected visual acuity, topographic indices, keratometric indices, contact lens parameters, and ocular aberrometric changes were evaluated. All patients were followed up for at least 3 months. Eighteen eyes of 17 patients were included in the analysis. The mean post-hydrops topographic values of the eyes included flat keratometric value (K1) 64.93±10.88 (range 44.30-93.40) diopters (D), steep keratometric value (K2) 70.41±10.92 D (range 45.8-98.6 D), and Kmax of 79.53±17.73 D (range 50-130.2). The final mini-scleral lens's mean dioptric power was -8.56±3.96 D (range -18 to -4). Visual acuity significantly improved from post-hydrops resolution uncorrected visual acuity of 1.5±0.71 logMAR to 0.79±0.18 logMAR best spectacles-corrected visual acuity to 0.27±0.01 logMAR best lens-corrected visual acuity ( P -value <0.0001). Similarly, there was considerable improvement in corneal aberrometric values after wearing an MSL. At the 3-month follow-up, 15 patients (16 eyes) were compliant to contact lens use with a minimum of 6 to 8 hr daily while two patients (2 eyes) were poorly compliant. A MSL is a valuable option for visual rehabilitation in keratoconus following the resolution of acute hydrops.

Strategies and Application of Compression Sutures With a Modified Technique for Rapid Resolution of Large (Grade III) Hydrops: A Prospective Interventional Study.

The aim of this study was to describe the strategies and outcomes, with a modified technique, of compression sutures in large acute hydrops. This was a prospective interventional study in 29 eyes of 28 patients who underwent compression sutures using a modified technique. The degree of resolution after surgical intervention was quantified by 3 masked observers, using the slit-lamp photographic documentation and optical coherence tomography. The degree of resolution, best-corrected visual acuity, and complications were analyzed. The mean age was 20.89 (7-46) years. Five patients had pellucid marginal degeneration (pellucid marginal corneal degeneration), 23 had keratoconus, and 1 had posttrauma hydrops. The preoperative visual acuity was hand motions in all eyes. The reduction in edema was 76% on day 1, 91.6% on 6 ± 2 days, 98.6% on 18 ± 3 days from surgical intervention. The baseline pachymetry assessed on optical coherence tomography was beyond measurement in 26 eyes. The mean pachymetry at day 1 was 704 μm (range 480-950) which reduced to 607 (range 422-850) microns at 6 ± 2 days and 518 (range 415-718) microns at 18 ± 3 days postintervention (P < 0.0001). The mean duration between the surgery and complete suture removal was 48 (35-68) days. No suture-related complications were noted. Twenty eyes could attain good visual rehabilitation with glasses/contact lenses (vision could not be assessed in 5 eyes). Penetrating keratoplasty was performed on 1 patient. Compression sutures using the modified technique was safe and effective in the rapid resolution of acute hydrops in keratoconus and pellucid marginal corneal degeneration. No complications were noted, and visual restoration with spectacles and contact lenses was satisfactory.

The pre-Descemet's layer (Dua's layer, also known as the Dua-Fine layer and the pre-posterior limiting lamina layer): Discovery, characterisation, clinical and surgical applications, and the controversy.

The pre-Descemet's layer/Dua's layer, also termed the Dua-Fine layer and the pre-posterior limiting lamina layer, lies anterior to the Descemet's membrane in the cornea, is 10 μm (range 6-16) thick, made predominantly of type I and some type VI collagen with abundant elastin, more than any other layer of the cornea. It has high tensile strength (bursting pressure up to 700mm of Hg), is impervious to air and almost acellular. At the periphery it demonstrates fenestrations and ramifies to become the core of the trabecular meshwork, with implications for intraocular pressure and glaucoma. It has been demonstrated in some species of animals. The layer has assumed considerable importance in anterior and posterior lamellar corneal transplant surgery by improving our understanding of the behaviour of corneal tissue during these procedures, improved techniques and made the surgery safer with better outcomes. It has led to the innovation of new surgical procedures namely, pre-Descemet's endothelial keratoplasty, suture management of acute hydrops, DALK-triple and Fogla's mini DALK. The discovery and knowledge of the layer has introduced paradigm shifts in our age old concepts of Descemet's membrane detachment, acute corneal hydrops in keratoconus and Descemetoceles, with impact on management approaches. It has been shown to contribute to the pathology and clinical signs observed in corneal infections and some corneal dystrophies. Early evidence suggests that it may have a role in the pathogenesis of keratoconus in relation to its elastin content. Its contribution to corneal biomechanics and glaucoma are subjects of current investigations.

Partial-thickness compression sutures without descemetopexy for management of acute hydrops in keratoconus: A novel surgical technique.

This article reports a novel surgical technique of partial-thickness compression sutures without descemetopexy with air or gas for the management of acute hydrops in keratoconus. Two patients presented with localized corneal edema with a Descemet membrane (DM) tear in the left eye. Tomography of the right eye revealed localized steepening with increased maximum keratometry and decreased central pachymetry. They were diagnosed with keratoconus in the right eye and acute corneal hydrops (ACH) in the left eye. Compression sutures were passed through the stroma without touching the DM. The anterior chamber was not entered at all at any point during the surgery. Resolution of edema was noted intraoperatively itself. Further resolution of edema was noted from the first postoperative day which markedly reduced within the first week. A corneal scar with no edema was seen at six weeks. In both the patients, vision at presentation was counting fingers close to face which improved to 20/60 and 20/50, respectively, at the last visit.

Comparative analysis of posterior cornea between hydrops in keratoconus and Haab's striae in primary congenital glaucoma

AbstractPurpose: More eyes with keratoconus (KC) require keratoplasty after hydrops when compared to those after haab striae in primary congenital glaucoma (PCG). To compare descemet's membrane (DM) tear morphology in KC and PCG eyes using ASOCT and histopathology.Methods: ASOCT of KC eyes with hydrops (n = 12) and PCG eyes with Haab's striae (n = 15) were evaluated and compared with healthy eyes (n = 14) for descemet's membrane/ pre‐descemet's layer (DM‐PDL) morphology. These features were also assessed on histopathology of corneal button obtained from KC eyes (n = 14) and PCG (n = 13) after keratoplasty and compared with control tissues (retinoblastoma not involving cornea, n = 6) on light microscopy and immunostaining.Results: ASOCT showed thinner DM‐PDL in KC eyes(47.1 ± 25.5 μ) than that of PCG (77.2 ± 26.2 μ) (p = 0.01) inside areas of healed hydrops/ Haab's striae. DM‐PDL detachment was seen in 90% of KC eyes and 26% of PCG eyes. The height and angle of DM‐PDL detachment of KC eyes was more than that of PCG eyes. Similar to ASOCT findings, histopathology showed thinner DM‐PDL in KC eyes (62.6 ± 57.3 μ) compared to PCG (80.3 ± 78.7 μ) inside areas of healed hydrops/ Haab's striae but thicker than that of controls (32.6 ± 7.8 μ) (p‐0.01).Conclusions: Lesser fibroproliferative response and greater height of detachment ensure a poor healing after acute DM/ PDL tears in KC. This differential response of the posterior cornea may be responsible for greater need for keratoplasty in KC versus in PCG.

Different compression sutures combined with intracameral air injection for acute corneal hydrops.

To evaluate the efficacy and safety of full-thickness sutures combined with intracameral air injection (FTS-AI) versus pre-Descemet's membrane sutures combined with intracameral air injection (PDS-AI) in the management of acute corneal hydrops in keratoconus. The research included 8 patients (8 eyes) suffering from acute corneal hydrops caused by keratoconus. Four patients were randomly assigned to FTS-AI. And the other four were randomly assigned to PDS-AI. Corneal oedema, visual acuity, corneal thickness were assessed during follow-up. The demographics, preoperative duration of symptoms and severity of corneal hydrops between the two groups were not significantly different. The mean corneal oedema resolution time after FTS-AI and PDS-AI were 11±1.15 and 15±1.41d, respectively (P=0.005). The maximum corneal thickness of the scarred region decreased in both groups at one week postoperatively (P<0.05). No obvious difference was found in the mean maximal corneal thickness between the two groups postoperatively. The BCVA improved significantly after FTS-AI and PDS-AI at three months postoperatively. No obvious difference was found in the BCVA after FTS-AI and PDS-AI at three months postoperatively. FTS-AI and PDS-AI are safe and effective therapies to accelerate the resolution of corneal oedema in acute corneal hydrops secondary to keratoconus. Despite faster resolution of corneal oedema in the FTS-AI group, we recommend PDS-AI to avoid potential endothelium cell damage.

Mini-DMEK for the Treatment of Chronic Focal Corneal Endothelial Decompensation

The purpose of the study was to evaluate the feasibility of mini-descemet membrane endothelial keratoplasty ("Mini-DMEK," graft diameter <5 mm) for the treatment of chronic focal corneal endothelial decompensation for reasons other than acute hydrops in patients with keratoconus. Of the 3010 patients registered in the prospective Cologne DMEK database, 16 patients with focal corneal endothelial decompensation treated with Mini-DMEK were identified. After exclusion of patients with acute hydrops in keratoconus (n = 9), indications for focal corneal endothelial decompensation were either defects in Descemet membrane after intraocular surgeries (n = 5) or corneal edema in the area of Haab striae in buphthalmus (n = 2). Best spectacle-corrected visual acuity, corneal thickness in the affected area, and rebubbling rates served as main outcome measures. All patients showed a postoperative increase in the best spectacle-corrected visual acuity from preoperative logarithm of the minimum angle of resolution (logMAR) 1.1 (±0.7) to logMAR 0.3 (±0.2) after the first month (P = 0.046) and to logMAR 0.3 (±0.2) after half a year (5-7 months) (P = 0.025). The corneal thickness decreased from preoperative 757 μm (±125) to 603 μm (±121) after the first month (P = 0.031) and to 593 μm (±131) after half a year (5-7 months) (P = 0.031). Rebubbling was necessary in 43% of patients (3 of 7 eyes). In 2 patients, Mini-DMEK was performed as triple Mini-DMEK including cataract surgery. Mini-DMEK is an effective treatment option for focal chronic corneal endothelial decompensation caused by tears in Descemet membrane or other defects such as Haab striae. Mini-DMEK can also be performed as a triple procedure including cataract surgery (triple Mini-DMEK).

One-step thermokeratoplasty for pain alleviating and pre-treatment of severe acute corneal hydrops in keratoconus.

To observe the efficacy of simplified one-step thermokeratoplasty for the treatment of severe acute corneal hydrops in keratoconus. In this retrospective, noncomparative clinical study, 10 patients (10 eyes) with acute hydrops in keratoconus were treated with simplified one-step thermokeratoplasty. Pain, changes in the corneal curvature, thickness, and size and morphology of the Descemet membrane breaks were detected before and after surgery. Eight patients were successfully treated using modified deep anterior lamellar keratoplasty (DALK). Graft transparency, visual acuity, and immunological rejection were evaluated for 6 to 12mo. Pain and corneal oedema were promptly alleviated, and the intrastromal ruptures diminished within 3 to 6wk after thermokeratoplasty. At 3 to 6wk after corneal oedema was faded, Descemet membrane breaks and intrastromal ruptures were healed. Two patients did not undergo subsequent corneal transplantation after thermokeratoplasty. Eight patients underwent DALK successfully and safely after thermokeratoplasty, without corneal perforation. Central corneal opacity faded or disappeared within 6mo. The mean best-corrected visual acuity was increased to 20/30 at 12 mo after DALK. No one was observed with any immune rejection. One-step thermokeratoplasty can successfully and efficiently accelerate the absorption of prominent corneal oedema in severe acute hydrops patients. This simple procedure with no complications can be performed in the emergency department by residents. This method can improve the safety of DALK and obtain good postoperative vision. Long-term management of acute corneal hydrops using simplified one-step thermokeratoplasty seems promising.

Compression sutures combined with intracameral air injection versus thermokeratoplasty for acute corneal hydrops: a prospective-randomised trial

AimsTo compare the efficacy of compression sutures combined with intracameral air injection (CSAI) and thermokeratoplasty (TKP) for the management of acute corneal hydrops in keratoconus.MethodsIn this multi-centre randomised clinical trial,...

Review on the Use of Topical Ocular Hypertonic Saline in Corneal Edema.

To review the effectiveness of topical ocular hypertonic saline in corneal edema. Online literature search of published articles on the effectiveness of topical hypertonic saline in corneal edema, bullous keratopathy (BK), and other associated corneal conditions in humans was performed on April 16, 2020. A total of 16 articles were reviewed after curation by the authors for relevance, with 4 randomized control trials, 6 prospective studies, 4 retrospective studies, and 2 case reports. Efficacy of hypertonic saline eye drops varied widely, depending on the specific corneal disorder being treated. Six of the studies involved BK (edema involves epithelium), 2 in corneal edema limited to the stroma, 5 in Fuchs dystrophy, 3 in filamentary keratitis (the presence of filaments attached to corneal epithelium), 2 in recurrent corneal erosion, and 1 in jellyfish stings. There was limited efficacy for hypertonic saline in BK, whereas clinical improvement was noted in most studies for corneal edema without epithelial involvement, especially if associated with Fuchs dystrophy or corneal hydrops in keratoconus. Hypertonic saline also seems to be beneficial for other corneal disorders, such as filamentary keratitis and jellyfish stings, but not in recurrent corneal erosion. Adverse effects from topical hypertonic saline include a mild stinging or burning sensation, with no serious complications having been reported. Topical ocular hypertonic saline seems to be a safe and effective treatment in the management of less severe forms of corneal edema and other corneal disorders such as filamentary keratitis.

Mini‐DMEK for focal defects of Descemet's membrane

AbstractIntroductionDescemet Membrane Endothelial Keratoplasty (DMEK) has evolved into a standard procedure for patients with corneal endothelial diseases. Recent reports suggest that DMEK can also improve corneal edema in patients with breaks in Descemet's membrane (DM) as in acute hydrops.MethodsThis is a retrospective analysis of consecutive patients after DMEK with small grafts (Mini‐DMEK) for the treatment of defects of DM. The size of the graft in Mini‐DMEK was adapted to the size of the defect of DM.ResultsFour out of six Mini‐DMEKs were performed in patients with acute hydrops in keratoconus. One Mini‐DMEK was performed in a patient with a large central tear after DALK and one Mini‐DMEK was performed in a patient with Haab's striae in primary congenital glaucoma. Incomplete graft attachment necessitated one re‐Mini‐DMEK in a patient with acute keratoconus. Intraoperatively, unfolding and positioning of small grafts turned out to be more complex than in DMEK with grafts of normal size (≥7 mm). After successful Mini‐DMEK corneal thickness and corneal edema decreased in all patients.ConclusionMini‐DMEK is a viable treatment option for patients with ruptures or breaks of DM. Future analysis are needed for better identification of patients with defects of DM who will benefit from Mini‐DMEK.

Acute Corneal Hydrops in Keratoconus With Atopic Dermatitis

Acute Corneal Hydrops in Keratoconus With Atopic Dermatitis

Mini-Descemet Membrane Endothelial Keratoplasty for the Early Treatment of Acute Corneal Hydrops in Keratoconus.

To describe a new surgical option for the treatment of acute corneal hydrops in keratoconus and to present the first results. This is a retrospective analysis of 3 patients who presented to our clinic with a massive corneal hydrops in acute keratoconus and were treated by mini-Descemet membrane endothelial keratoplasty (DMEK). According to the size and the shape of the gap in the patient's Descemet membrane (DM), 1 DMEK graft was trephined with a round 5-mm punch. The other grafts were trimmed with a razor blade to a width of about 3 mm and a length adjusted to the length of the defect of the recipients' DM. The graft was inserted with a regular intraocular lens shooter. Correct unfolding of the graft was controlled by using intraoperative optical coherence tomography. At the end of the surgery, the graft was attached to the posterior corneal surface by a small air bubble. Thereafter, the complete anterior chamber was filled with 20% SF6 gas. All 3 patients (age 32 ± 3 years on average) showed a rapid increase in uncorrected visual acuity from the logarithm of the minimum angle of resolution (LogMAR) 1.66 (±0.46) before mini-DMEK to the LogMAR 1.2 (±0.3) within 6 to 8 weeks after mini-DMEK. The thickest corneal point within the edematous cornea decreased in all 3 patients (1088 ± 280 μm before surgery vs. 630 ± 38 μm 1 week after surgery). One mini-DMEK failed in a first attempt. In this patient, the recipient DM was under strong tension and showed a pronounced dehiscence. Therefore, a small part of the recipient's DM around the preexisting gap in DM was removed before a second mini-DMEK graft was placed successfully. The other 2 patients developed partial graft detachment within 1 to 2 weeks after surgery. However, the corneas of these patients were dehydrated to physiological levels after mini-DMEK, and despite partial detachment, there was no relapse of the hydrops. Mini-DMEK could be helpful in patients with larger defects and detachments of DM in very ectatic corneas in the acute phase of corneal hydrops in acute keratoconus. These patients may not be successfully treated by intracameral gas application alone or in combination with pre-Descemetal sutures. Further investigations are needed to identify factors helping to decide on the best surgical approach in hydrops in acute keratoconus.

The Outcome of Scleral Lens Fitting for Keratoconus With Resolved Corneal Hydrops.

To investigate the success and failure of scleral lens fitting in patients with keratoconus with resolved hydrops. Retrospective case series of patients with keratoconus who attended the Ophthalmology Department at Antwerp University Hospital, Belgium, and developed acute hydrops between January 1, 2015, and June 30, 2018. The exclusion criteria included amblyopia, mental retardation, and insufficient follow-up. Of the 25 patients with keratoconus with acute hydrops, 14 patients (16 eyes) were included in this study. Median age was 31 years (range 19-52 years). Before hydrops, the median maximum keratometry value of affected eyes was 81.3 D (range 66.3-108.3 D). Acute hydrops was managed medically in 5 eyes (31.3%), by observation in 5 eyes (31.3%), by application of bandage contact lens in 1 eye (6.3%), and compression corneal sutures in 5 eyes (31.3%). Contact lens fitting after hydrops was not necessary for 2 patients (2 eyes; 12.5%) because of excellent vision in the fellow eye. Of the remaining patients, 11 (68.8%) were successfully fitted with mini-scleral lenses, with a median visual acuity of 0.7 (0.5-0.9; decimal Snellen). Three patients (3 eyes; 18.8%) proceeded to graft surgery because of limited visual acuity with scleral lenses (n = 2) or persistent edema (n = 1). Scleral lenses are effective for providing satisfactory visual acuity after corneal hydrops in keratoconus. A scleral lens trial is advised before listing patients for graft surgery.

Regression of Corneal Vascularization Occurring after Corneal Suturing in a Case of Acute Hydrops Managed with a Combination Therapy of Argon Laser Photocoagulation and Intrastromal Ranibizumab Injection: A Case Report

ABSTRACT Aim To report a case of acute hydrops with a large stromal cleft, in a case of keratoconus, managed with compression sutures and perfluoropropane (C3F8) descemetopexy and subsequent management of corneal vascularization in that eye with combination therapy of laser and anti-vascular endothelial growth factor (anti-VEGF). Background Acute hydrops in keratoconus occurs following a tear or rupture in the Descemet's membrane (DM), resulting in aqueous percolating into the stroma. The presence of large stromal clefts in acute hydrops has been described as a known risk factor for delayed resolution and persistent edema, which in turn can incite inflammation and vascularization and thereby adversely affect the chances of graft survival later. We describe such a case managed effectively with a combination of different treatment modalities. Case description A 12-year-old boy with keratoconus presented with acute hydrops in his left eye. The acute hydrops was managed with compression sutures along with C3F8 descemetopexy. Subsequent development of persistent deep corneal vascularization and recurrence of inflammation after the resolution of hydrops was managed with a combination of argon laser photocoagulation and intrastromal anti-VEGF injections, resulting in complete regression of the deep vascularization and resolution of inflammation. Conclusion In our case, a combination of management modalities to address severe acute hydrops and its subsequent complications resulted in complete regression of the superficial and deep vessels, thus heralding an optimal outcome for a future corneal graft. Clinical significance There are no definite guidelines for the management of acute hydrops in keratoconus. A customized and judicious combination of various treatment modalities described in the literature for acute hydrops and its sequelae can result in an accepted outcome, which can pave the way for an optimum result with elective treatments like keratoplasty later on. How to cite this article Kurian A, Reghunadhan I, Soman M, et al. Regression of Corneal Vascularization Occurring after Corneal Suturing in a Case of Acute Hydrops Managed with a Combination Therapy of Argon Laser Photocoagulation and Intrastromal Ranibizumab Injection: A Case Report. Int J Kerat Ect Cor Dis 2019;8(2):46–49.

Acute severe corneal hydrops in keratoconus

Acute severe corneal hydrops in keratoconus

Keratokonusta Akut Korneal Hidropsun Cerrahi Tedavisi

Keratokonusta Akut Korneal Hidropsun Cerrahi Tedavisi

Management of acute corneal hydrops in keratoconus with pre‐Descemet's membrane sutures

PurposeTo report three cases of corneal hydrops in patients with keratoconus that were managed with pre‐descemet's membrane (DM) sutures associated with intracameral air injection assisted with the ZEISS RESCAN 700 surgical microscope under general anesthesia to shorten the period of corneal edema, to achieve corneal stability and to reduce the duration of the use of carbonic anhydrase inhibitor.MethodsThe first patient, a 27‐year‐old man affected by a Down's syndrome associated with a bilateral keratoconus presented with corneal hydrops in his right eye resulting from a central vertical tear in DM. Three horizontal pre‐DM sutures were performed. The second patient, a 26‐year‐old man affected by a Down's syndrome associated with a bilateral keratoconus presented with corneal hydrops in his left eye resulting from a central horizontal tear in DM. Five vertical pre‐DM sutures were achieved. The third patient, a 43‐year‐old woman with bilateral keratoconus presented with corneal hydrops in her left eye resulting from a central vertical tear in DM. Four horizontal pre‐DM sutures were achieved.ResultsOne month after the pre‐DM sutures, the edema resolved clinically and the pachymetry dramatically decreased on anterior segment OCT. The visual acuity of the Two first patients, while subjectively improved, were not measurable, the third patient visual acuity improved from counting fingers at 1 foot to 1,4logMAR at 20 foots from day one to month six.ConclusionsIntrastromal pre‐DM sutures and intracameral air injection could promptly restore imperviousness of posterior stroma. This technique seems to be a useful procedure to shorten acute corneal hydrops. This impressive clinical response to stromal sutures led us to hypothesize that the pathogenesis of corneal hydrops may correspond to an acute ‘fracture’ of the corneal stroma secondarily leading to DM tear.

Case-control study of risk factors for acute corneal hydrops in keratoconus

PurposeTo determine risk factors for the development of acute corneal hydrops in keratoconus in the UK in a case-controlled study.MethodsBetween November 2009 and December 2010, we prospectively identified 73 individuals...

Deep anterior lamellar keratoplasty using the same graft after epikeratophakia for the treatment of acute corneal hydrops in keratoconus

Objective To evaluate the clinical effects of deep anterior lamellar keratoplasty (DALK) using the same graft after epikeratophakia for the treatment of acute corneal hydrops in keratoconus. Methods A consecutive 7 cases (7 eyes) with acute corneal hydrops in keratoconus in our department were retrospectively analyzed. Same corneal graft was used to perform the first stage epikeratophakia combined with C3F8 anterior chamber injection. About 6 months after the first surgery, the secondary stage deep anterior lamellar keratoplasty combined with air anterior chamber injection was performed. The best corrected visual acuity, healing status of the anterior and posterior corneal surface, anterior segment optical coherence tomography parameters, and corneal endothelial cells density were recorded. Results The central corneal thickness was (1764±256) μm before the treatment, and it was (778±147) μm, (604±23) μm, (579±20) μm and (525±19) μm at the time points of 1 d, 7 d, 1 and 6 months after the first stage surgery respectively. An average (6.1±1.3) months after the first stage surgery, the second stage DALK was performed. The descemet's membrane at the central area could be fully exposed in 3 eyes. Slow liquid exudations in the deep corneal stroma near the descemet's membrane were found in the other 4 eyes during stroma dissection. DALKs were successfully performed in all the 7 cases. Double anterior chambers were found in 2 eyes 1d after DALK. The whole corneal thicknesses were (781±57) μm, (581±49) μm and (521±19) μm at 7 d, 1 and 3 months after DALK respectively. Three months later, the thickness of the receptors' residual stroma bed was (21±11) μm at the central corneal area. At the end of the follow-up, the BCVA(LogMAR)was 0.11±0.03. Conclusion Novel curative effect was found in the treatment of acute corneal hydrops in keratoconus by deep anterior lamellar keratoplasty using the same graft after epikeratophakia. Key words: Acute corneal hydrops, keratoconus; Epikeratophakia; Keratoplasty, deep anterior lamellar; Anterior segment optical coherence tomography; Descemet's membrane