Aim To evaluate outcomes of deep anterior lamellar keratoplasty (DALK) in keratoconic eyes with previous hydrops.

Methods In this retrospective, non-comparative study, keratoconic eyes with previous hydrops that underwent DALK were included. DALK was performed using a modification of Melles's technique of optical recognition with pre-Descemet's membrane dissection. Data on preoperative and postoperative uncorrected distance visual acuity and best spectacle corrected distance visual acuity (BSCVA), postoperative spherical equivalent (SEQ); keratometry and adverse events were recorded for all eyes.

Results Ten eyes (10 patients) underwent DALK in keratoconic eyes with previous hydrops. Mean follow-up was 56.4±23.8 months. Preoperatively BSCVA was 6/24 or worse in all eyes. At last follow-up, 100% had BSCVA of 6/12 or better. Intraoperative microperforation at the site of previous hydrops occurred in six eyes but none required conversion to penetrating keratoplasty. At latest follow-up, mean SEQ was −2.4±4.2D, keratometric astigmatism was 3.8±1.6D and refractive astigmatism was 3.4±2.2D. Mean postoperative keratometry was 43.7±2.6 and central pachymetry 572.6±65.0 µm.

Conclusions DALK in keratoconic corneas with prior hydrops is a safe and effective option that preserves host endothelium Intraoperative microperforations at the site of hydrops are common, however with good management favourable outcomes are possible.