Effect of lamellar keratoplasty after pre-Descemet’s membrane suture healing of acute corneal hydrops

Effect of lamellar keratoplasty after pre-Descemet’s membrane suture healing of acute corneal hydrops | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of lamellar keratoplasty after pre-Descemet’s membrane suture healing of acute corneal hydrops jie bai, Chang Liu, Shaowei Li, Lin Zhao, Ling Li, Wenxiu Song, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2392446/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This study aimed to observe the effect of lamellar keratoplasty (LK) after pre-Descemet’s membrane (pre-DM) suture healing of acute corneal hydrops (ACH). Methods: In a retrospective noncomparative case series, 11 patients (11 eyes) with ACH, who underwent pre-DM suture combined with intracameral air injection in the acute stage, underwent LK when the oedema subsided. During surgery, the diseased cornea was stripped layer by layer, and a mild scar in the deep stroma occasionally remained. The age, sex, diagnosis, scope of acute corneal oedema, size and location of scar after oedema healing, operation interval, postoperative best-corrected visual acuity (BCVA), astigmatism, and intraoperative and postoperative complications were recorded. Results: The average follow-up time was 15.45 ± 8.54 months (6–30 months). The average time from corneal suture to LK was 41.91 ± 36.39 days. After LK, the BCVA was 0.52 ± 0.18 (0.15–0.8), astigmatism on the front surface of corneal topography was 5.63 ± 1.28 D, and apparent optometry CYL was -4.50 ± 1.87 D. The central corneal thickness was 552.81 ± 62.81 μm (449–637 μm). Microperforation occurred in two cases. No other complications occurred in any patients until the last follow-up. Conclusions: LK can be performed earlier after the pre-DM suture of ACH. The combination of the two can shorten the overall course of the disease, significantly improve vision, and avoid the complications of penetrating keratoplasty. Acute corneal hydrops Pre-Descemet’s membrane Complications Lamellar keratoplasty Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Acute corneal hydrops (ACH) occurs in approximately 2.6–2.8% of patients with keratoconus [ 1 , 2 ]. ACH presents with corneal oedema because of a tear in Descemet’s membrane (DM) and endothelium, followed by leakage of aqueous humour into the stroma. The presentation includes severe vision loss, photophobia, redness, and grey eye [ 3 ]. ACH can self-heal over 2–6 months, depending on the extent of DM rupture. During this process, complications may occur, such as infection, intrastromal cleft formation, perforation, corneal neovascularisation, and a greater risk of corneal rejection after keratoplasty [ 4 – 6 ]. In the past 20 years, different treatments for ACH have been studied [ 7 ]. The objectives are to hasten the resolution of oedema, improve vision, or prepare for further surgery. Many studies have proposed various methods to promote oedema resorption [ 8 – 13 ]. While some studies argue that the risk of perforation may occur with deep lamellar keratoplasty (DLK) in the scar after ACH healing, recent studies argue that DLK can effectively improve vision after the oedema resolves [ 14 – 17 ]. To the best of our knowledge, this is the first study to observe the effect of lamellar keratoplasty (LK) or DLK in healed hydrops, performed after pre-DM sutures combined with intracameral air injection. Methods Patients The data of 11 patients (11 eyes) with ACH who presented at Beijing Aier-Intech Eye Hospital between January 2016 and December 2021 were retrospectively collected. These patients, who had undergone pre-DM sutures combined with intracameral air injection in the acute stage, underwent LK once oedema subsided. Before the LK, the corneal scar was located in the central or paracentral area of the cornea, and the patients were dissatisfied with the best-corrected visual acuity (BCVA). The patients were followed up for 18.75 ± 15.53 months (6–60 months). This study was approved by the Institutional Review Board (BJAIER2021IRB18) of Beijing Aier-Intech Eye Hospital and followed the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients or their legal guardian(s), and LK was performed by a single surgeon. The data collected included the patient’s age, sex, diagnosis; location and extent of the oedema; central corneal thickness (CCT); size, depth, and location of scar after ACH healing; BCVA; curvature and astigmatism of corneal topography; and spherical (S) and cylindrical (CYL) power at 1, 3, and 6 months and on the last follow-up. Surgical technique LK After ACH healed, LK surgery was performed. Although we were as close to the DM as possible, DM was not exposed completely; thus, it was near-DLK. The corneal trephine diameter was determined by measuring the area of scar involvement. Next, the host cornea was trephined to approximately 50% of its thickness, and 80% of the corneal depth was drilled and stripped layer by layer by the blade tip. Owing to the scar, big bubbles could not be used; therefore, we used small bubbles to separate the stroma and help determine the stripping depth. Anterior chamber paracentesis reduced the intraocular pressure to avoid DM tears. In the scar, the risk of perforation is high because the stroma and DM adhere closely and must be peeled carefully from the periphery going inwards without pulling. The implant bed was then kept as thin as possible, and the use of microsurgical scissors was preferred to blades. When microperforation occurs, anterior chamber gas injection can help complete the operation because air can block the leakage of the aqueous humour. The donor button of all patients was made into appropriately sized grafts according to the length of the patient’s visual axis. The donor button was placed on the recipient bed and sutured with 16 interrupted 10/0 nylon sutures. The patients were administered tobramycin dexamethasone (Tobrex, Alcon NV, Switzerland) eye drops four times a day and ointments once nightly for the first month after the operation and reduced gradually according to the eye condition. If the suture loosens within 3 months, it needs to be resutured, but if it loosens after 3 months, it can be removed. After 6 months, the corneal sutures were removed selectively based on corneal astigmatism. Evaluation of corneal oedema The grading standard of corneal oedema was as follows [ 8 ]: grade I, within a circle of 3 mm diameter; grade II, within circles of 3–5 mm diameters; and grade III, larger than a circle of 5 mm diameter. The grading standard of corneal scar degree was as follows: grade I, not involving the pupil area; grade II, pupil area < 1/2; and grade III, pupil area ≥ 1/2. Results LK was performed in 11 patients (eyes), including 10 men (90.91%) and 1 woman (9.09%), with an average age of 19.91 ± 4.01 years (15–28 years). Table 1 describes the pre-operational general conditions and corneal characteristics, including sex, age, the extent and grade of ACH oedema, the location and size of the scar after the oedema resolved, the time interval between LK and suture, and the changes in vision and astigmatism. All eyes had corneal scars graded II or greater, including eight eyes (72.73%) with grade III corneal scars. The average time of corneal oedema reduction was 11.18 ± 7.45 days. After the oedema resolved, the degree of the corneal scar was grade II or above, involving the pupil, and six (54.55%) of the patients had a grade III scar. The average follow-up time was 15.45 ± 8.54 (6–30) months. The follow-up time for seven eyes was ≥ 1 year. The BCVA of all patients before DLK was ≤ 0.3 (0.17 ± 0.14, 0.01–0.3). The average interval between the pre-DM suture and LK was 41.91 ± 36.39 (6–133) days (Table 1 ). The BCVA after corneal transplantation was improved. The BCVA at the last follow-up was 0.52 ± 0.18 (0.15–0.7), of which eight eyes had BCVA ≥ 0.5. The average astigmatism of the anterior surface of corneal topography was 5.63 ± 1.38 D, and the average CYL of optometry was − 4.50 ± 1.87 D (Table 2 ). Microperforation occurred in two cases, but the LK was completed successfully. The residual scar of most cases decreased over time, and vision continued to improve. In some cases where the scar was located in the pupil area, the postoperative vision also exceeded expectations. After the operation, five eyes had double anterior chambers, of which four were well attached after applying liquid between the layers, and in one eye, the double anterior chambers disappeared spontaneously. The average CCT at the last follow-up was 552.81 ± 62.81 µm (449–637 µm). No rejection and other complications occurred in all patients until the last follow-up (Table 2 ). Table 1 General preoperative condition and corneal characteristics Patient no. Sex Age (years) Extent of oedema (mm) Grading standard of corneal oedema Cornea oedema resolution time Grading standard of scar after the oedema healed Corneal Scar range (mm) BCVA before keratoplasty Time interval between DLK and suture (d) 1 M 18 5.53 *3.67 III 18 III 5.43*2.00 0.01 21 2 M 22 5.40*4.13 III 14 III 4.67*3.38 0.3 80 3 M 17 7.90*7.31 III 28 III 6.55*3.02 0.15 25 4 M 28 4.47*4.10 II 7 III 5.07*2.26 0.2 34 5 M 20 5.26*4.40 III 5 II 3.56*2.89 0.1 6 6 M 19 3.86*2.70 II 15 II 4.60*2.51 0.02 19 7 M 25 4.68*3.25 II 3 II 4.39*2.07 0.3 32 8 M 15 7.78*5.94 III 13 II 5.57*3.33 0.5 21 9 M 22 6.43*6.09 III 5 III 7.57*1.25 0.3 133 10 M 16 8.07*6.63 III 10 II 6.00*3.41 0.1 58 11 F 17 6.80**5.67 III 5 III 5.21*2.26 0.2 32 Table 2 Intraoperative and postoperative data recording of pre-DM DLK Patient no. Microperforation during surgery Suture pattern Postoperative data Double chamber after surgery Follow-up (months) Last follow-up data BSCVA Pentacam Optometry CCT (µm) K1 K2 Kmean Astig S CYL 1 No I Yes 16 0.7 40.2 45.6 42.7 5.4 -5.00 -5.00 557 2 Yes I No 30 0.5 42.9 48.1 45.4 5.2 -2.00 -4.00 449 3 No I Yes 7 0.5 43.4 47.9 45.6 4.5 + 1.00 -3.75 473 4 No I No 24 0.3 42.1 48.9 45.2 6.7 -4.50 -5.00 580 5 No I No 12 0.4 45.4 49.4 47.3 4 -4.75 -4.75 588 6 No I Yes 29 0.15 55.1 56.6 55.8 5.5 -1.00 -2.75 637 7 No I No 15 0.6 41.0 47.3 43.9 6.3 + 4.00 -6.50 625 8 No I No 12 0.6 50.4 59.1 54.5 8.7 -9.25 -8.25 484 9 No I Yes 6 0.6 42.0 47.5 44.6 5.5 -4.00 -4.50 545 10 No I No 11 0.8 42.7 48.5 45.4 5.6 -1.00 -1.00 607 11 Yes I No 8 0.6 41.5 46.0 43.6 4.5 -3.75 -4.00 536 Discussion The self-healing time for ACH is long, and conservative management does not hasten healing. The healing time of oedema in treating corneal sutures was significantly shorter than that of self-healing [ 12 , 13 ]. In this study, the reducing time after corneal suture was 11.18 ± 7.45 days, significantly shorter than that after conservative management. Some patients had significant regression of corneal oedema within 5days after suture placement (Fig. 1 ). Corneal oedema subsided in approximately 2 weeks in the present study, which is consistent with the results presented by Zhao et al. and Cherif et al. [ 12 , 13 ]. However, previous studies did not further explore the follow-up treatment after healing. Keratoconus occurs in young patients, and the age onset of ACH is younger. Therefore, the long-term survival of corneal grafts is very important. For young patients with keratoconus, DLK is the first choice. However, DLK has not been considered for deep scars involving DM for many years because of the risk of perforation [ 8 ]. Das et al. first reported a case of DLK after ACH healing. Although a scar was left in the optic axis area, the BCVA recovered to 1.0 [ 18 ]. Anwar et al. observed 22 eyes and performed near-Descemet dissection deep antibiotic lamellar keratoplasty on the patients after the ACH healing; perforation occurred in 6 eyes, and the operation was completed through intracameral gas injection [ 14 ]. These studies provide valuable information regarding the feasibility of subsequent DLK. Previous studies mainly focused on DLK after self-healing of ACH. Zhao et al. [ 17 ] reported that 65% of patients had a BCVA of 0.63 (0.2 LogMAR) or better 24 months after the operation. In the 3-year follow-up results of Anwar et al., the average BCVA was approximately 0.5, and approximately 68% of the patients had BCVA ≥ 0.5 [ 14 ]. In our study, the average BCVA was 0.52 ± 0.18 (0.15–0.8). Eight (72.73%) patients had a BCVA of 0.5 or better, while 6 (54.55%) had a BCVA of ≥ 0.6. To the best of our knowledge, we are the first to observe the LK effect after pre-DM sutures. Our visual acuity results were similar to the two previous studies. Our patients had no rigid gas permeable contact lens vision correction, or the BCVA could have been better. Few studies discuss the appropriateness of surgery. When the scar persists for a long time, the DM closely adheres to the stroma, increasing the difficulty of DLK and the risk of perforation. The scar also affects vision because it cannot be peeled off. Chew et al. advocated that DLK be performed no sooner than 4 months after the occurrence of hydrops because the healing process takes 4–6 months to be completed [ 16 ]. In our study, pre-DM sutures shorten the healing time of the ACH. Our results showed that LK was performed in all patients. The average interval between the pre-DM sutures and LK was 41.91 ± 36.39 days (6–133 days). We tried to perform LK at different times after the corneal oedema subsided. The LK time was gradually shortened from 4 months after the corneal oedema subsided. Most operations were completed in 3 weeks to 1 month. One case underwent LK 6 days after suture. A relatively good vision could be obtained in most patients. Therefore, surgery may be performed earlier, which may reduce the residual scar. One month after suturing may be a suitable interval. The corneal scar may still remain oedematous in some patients at this time, such that the residual scar may be uneven during the surgery, but it will improve with time. Nevertheless, further research on the optimal interval is needed before firm recommendations can be made. However, because the healing of the DM rupture was not tight in the early stage, the big bubble technique could not be utilised to separate the stroma to avoid perforation. Pre-DM LK with manual stripping could be used. This method may affect vision in a few cases because of the non-uniform thickness of the recipient implant bed. This view is consistent with that of Nanavaty et al. [ 15 ]. In our study, one patient’s postoperative BCVA was poor as the implant bed was thicker and more uneven (Fig. 2 ). Therefore, we used microsurgical scissors to thin the implant bed. The scar, especially in the pupil area, was surgically excised as completely as possible. Anwar et al. found that the postoperative vision with residual scar is lower than that with penetrating keratoplasty and DLK without a scar. It is believed that the location and size of the scar impact the vision to some extent [ 14 ]. However, Zhao et al. found that the slight residual scars on the implant bed have no significant impact on the vision [ 17 ], consistent with the results of our study. We found that in the early stage of healing after keratoplasty, the stromal oedema in the residual scar area affects vision. Over time, the stromal oedema will reduce, and vision will improve (Figs. 3 – 5 ). In this study, most patients had a mild residual scar, but the average postoperative vision was 0.52 ± 0.18 (0.15–0.8). Therefore, we believe that retaining a mild scar may affect vision slightly, but it has less risk and greater benefit. Conclusions For ACH after suture of pre-DM, LK after ACH healing is an effective method to improve the vision, and the residual scar of deep stroma will not significantly affect the outcome. In our study, most patients can be performed LK in approximately 1 month. The suture of pre-DM combined with the LK can significantly shorten the healing time of the disease. This study provides a feasible method for the further treatment of ACH after suture of pre-DM. This study has limitations. A larger series with a longer follow-up period is necessary to confirm the results. In addition, further studies should be conducted to assess the timing and methods of operation after suturing. Declarations Ethics approval and consent to participate This study approved by the Institutional Review Board (BJAIER2021IRB18) of Beijing Aier-Intech Eye Hospital and followed the tenets of the Declaration of Helsinki. Written informed consent for participation was obtained from all patients. The informed consent for all participants below the age of 16 was obtained from their parents or their legal guardian(s). Consent for publication All study participants provided informed consent for publication. The informed consent of publication for all participants below the age of 16 was obtained from their parents or their legal guardian(s). Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Science Research Foundation of Aier Eye Hospital Group (grant number AR2104D3). Authors’ contributions All authors contributed to the study conception and design. JB and CL contributed to analysis and interpretation of data and drafted the manuscript. LZ, LL, WXS and LPH contributed to data analysis. SWL has reviewed this manuscript and given final approval. All authors commented on previous versions of the manuscript. All authors have read and approved the manuscript. Acknowledgements We would like to thank Editage (www.editage.cn) for English language editing. References Amsler M. Some data on the problem of keratoconus[J]. Bull De La Societe Belge Dophtalmologie. 1961;129:331–54. Tuft SJ, Gregory WM, Buckley RJ. Acute Corneal Hydrops in Keratoconus[J]. Ophthalmology. 1994;101(10):1738–44. Maharana PK, Nagpal R, Sharma N. Corneal Hydrops in Keratoconus[J]. Indian J Ophthalmol. 2015;4(8):52–5. Meyer JJ, McGhee CN. Acute corneal hydrops complicated by microbial keratitis: case series reveals poor immediate and long-term prognosis. Cornea. 2016;35(7):1019–22. Feder RS, Wilhelmus KR, Vold SD, et al. Intrastromal clefts in keratoconus patients with hydrops. Am J Ophthalmol. 1998;126(1):9–16. García-Albisua AM, Davila-Avila N, Hernandez-Quintela E, et al. Visual and Anatomic Results After Sole Full-Thickness Sutures for Acute Corneal Hydrops[J]. Cornea. 2020;39(5):661–5. Oteyza G, Bregliano G, Sassot I, et al. Primary surgical options for acute corneal hydrops: A review:[J]. Eur J Ophthalmol. 2022;32(2):781–9. Miyata K, Tsuji H, Tanabe T, et al. Intracameral air injection for acute hydrops in keratoconus[J]. Am J Ophthalmol. 2002;133(6):750–2. Panda A, Aggarwal A, Madhavi P, et al. Management of acute corneal hydrops secondary to keratoconus with intracameral injection of sulfur hexafluoride (SF6).[J]. Cornea. 2007;26(9):1067–9. Basu S, Vaddavalli PK, Ramappa M, et al. Intracameral Perfluoropropane Gas in the Treatment of Acute Corneal Hydrops[J]. Ophthalmology. 2011;118(5):934–9. Rajaraman R, Singh S, Raghavan A, et al. Efficacy and safety of intracameral perfluoropropane (C3F8) tamponade and compression sutures for the management of acute corneal hydrops.[J]. Cornea. 2009;28(3):317–20. Zhao Z, Wu S, Ren W, et al. Compression sutures combined with intracameral air injection versus thermokeratoplasty for acute corneal hydrops: a prospective-randomised trial[J]. Br J Ophthalmol. 2020;105(12):1645–50. Yahia Chérif H, Gueudry J, Afriat M, et al. Efficacy and safety of pre-Descemet's membrane sutures for the management of acute corneal hydrops in keratoconus[J]. Br J Ophthalmol. 2015;99(6):773–7. Anwar HM, Anwar M. Predescemetic dissection for healed hydrops–judicious use of air and fluid.[J]. Cornea. 2011;30(12):1502–9. Nanavaty MA, Da Ya SM. Outcomes of deep anterior lamellar keratoplasty in keratoconic eyes with previous hydrops.[J]. Br J Ophthalmol. 2012;96:1304–9. Chew A, Mehta JS, Tan D. Deep lamellar keratoplasty after resolution of hydrops in keratoconus.[J]. Cornea. 2011;30:454–9. Zhao Z, Li J, Zheng Q, et al. Wet-Peeling Technique of Deep Anterior Lamellar Keratoplasty with Hypotonic Water and Blunt Dissection for Healed Hydrops[J]. Cornea. 2017;36:386–9. Das S, Dua N, Ramamurthy B. Deep lamellar keratoplasty in keratoconus with healed hydrops.[J]. Cornea. 2007;26(9):1156–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2392446","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":166057707,"identity":"b52bb1a1-0f6b-4d87-af26-c7d5fc4e50dc","order_by":0,"name":"jie bai","email":"","orcid":"","institution":"Beijing Aier-Intech Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"jie","middleName":"","lastName":"bai","suffix":""},{"id":166057709,"identity":"a1febf57-a06d-4991-a340-7f637a836e64","order_by":1,"name":"Chang Liu","email":"","orcid":"","institution":"Beijing Aier-Intech Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chang","middleName":"","lastName":"Liu","suffix":""},{"id":166057710,"identity":"e946e086-e37c-42d7-aeb1-030a480526da","order_by":2,"name":"Shaowei Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBACPmYGNjCDjb2B4QCQTmAjpIUNroXnALFaGKBaGCQSwFQCQYexsbM/e/Cj4rAcn+Tjhwc+7rHL45NufsDwo2IbHofxmBv2nDlszCadZnBwxrPkYjaZYwaMPWdu49PCJsHbdjuxTTrB4DDPgQOJbRIJBsyMbfi0sD+T/Nt2u75N8viHw3/AWtI/ENDCYCYNtCWBTYLH4DADWEsOIVt4zKRlzvw3bOPJKTjYcyAZpAXIwOMXfv7jzyTfVKTJy7cf3/zhxwG7xPkz0jcCwxC3FuzgAInqR8EoGAWjYBSgAQCfqFOKiWuJvwAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing Aier-Intech Eye Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shaowei","middleName":"","lastName":"Li","suffix":""},{"id":166057711,"identity":"0d511da8-f37f-4bd0-9c56-4979d2f28f03","order_by":3,"name":"Lin Zhao","email":"","orcid":"","institution":"Beijing Aier-Intech Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Zhao","suffix":""},{"id":166057713,"identity":"07c86bff-1528-453e-9fdb-eb67ba6051e0","order_by":4,"name":"Ling Li","email":"","orcid":"","institution":"Beijing Aier-Intech Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ling","middleName":"","lastName":"Li","suffix":""},{"id":166057715,"identity":"99a4bb21-7a2d-42c5-a307-f722cfbb63f8","order_by":5,"name":"Wenxiu Song","email":"","orcid":"","institution":"Beijing Aier-Intech Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenxiu","middleName":"","lastName":"Song","suffix":""},{"id":166057717,"identity":"f3b2c6bf-1fbd-499c-9f11-09ed549ebbe6","order_by":6,"name":"Luping Hu","email":"","orcid":"","institution":"Beijing Aier-Intech Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Luping","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2022-12-19 07:44:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2392446/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2392446/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":31430693,"identity":"c4a8009b-acae-4300-b2c6-7d371b0c17e4","added_by":"auto","created_at":"2023-01-11 15:33:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1672900,"visible":true,"origin":"","legend":"\u003cp\u003eCase 11 A, corneal oedema in the acute stage; B, corneal oedema significant regression within 5days after pre-DM sutures combined with intracameral air injection.\u003c/p\u003e","description":"","filename":"FIG1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2392446/v1/ff9143f4a39e012377face42.jpg"},{"id":31430695,"identity":"e6be377c-e118-484f-9603-95dd0fc59531","added_by":"auto","created_at":"2023-01-11 15:33:19","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8867992,"visible":true,"origin":"","legend":"\u003cp\u003eCase 6 had poor postoperative BCVA. Anterior segment optical coherence tomography shows that the implant bed is thicker and more uneven.\u003c/p\u003e","description":"","filename":"FIG2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2392446/v1/3c1fd268c0ed6798b713b30b.jpg"},{"id":31430696,"identity":"e8cdc98b-49ef-4ba5-9196-4d0b181ce186","added_by":"auto","created_at":"2023-01-11 15:33:19","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":8396717,"visible":true,"origin":"","legend":"\u003cp\u003eCase 2 A, corneal oedema in the acute stage; B, corneal oedema subsided after pre-DM sutures combined with intracameral air injection; C–D, 1 week and 1 year after LK respectively, the stromal oedema in the residual scar area reduced.\u003c/p\u003e","description":"","filename":"FIG3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2392446/v1/ea731b7a5c0edd6510b98a38.jpg"},{"id":31430694,"identity":"82f3923c-196d-4d90-967c-f1ab20925005","added_by":"auto","created_at":"2023-01-11 15:33:19","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":7774150,"visible":true,"origin":"","legend":"\u003cp\u003eCase 5 A, corneal oedema in the acute stage; B, corneal oedema subsided after pre-DM sutures combined with intracameral air injection; C–D, 1 day and 1 year after LK respectively, the stromal oedema in the residual scar area reduced.\u003c/p\u003e","description":"","filename":"FIG4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2392446/v1/d773d95f48545cf9f94b7f25.jpg"},{"id":31431862,"identity":"f36aa39d-165c-4abc-a2a7-1e813209b5ad","added_by":"auto","created_at":"2023-01-11 15:41:19","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":7585052,"visible":true,"origin":"","legend":"\u003cp\u003eCase 11 A, corneal oedema in the acute stage; B, corneal oedema subsided after pre-DM sutures combined with intracameral air injection. C–D, 2 months and 6 months after LK respectively, the stromal oedema in the residual scar area reduced.\u003c/p\u003e","description":"","filename":"FIG5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2392446/v1/708ca39d73c297cf7188d542.jpg"},{"id":37998510,"identity":"d6a60ef5-0c14-43ba-ac40-4f5df6e6d250","added_by":"auto","created_at":"2023-06-05 06:44:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":635876,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2392446/v1/aaca4ed2-21d8-421b-a322-5f8d5add7079.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of lamellar keratoplasty after pre-Descemet’s membrane suture healing of acute corneal hydrops","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute corneal hydrops (ACH) occurs in approximately 2.6\u0026ndash;2.8% of patients with keratoconus [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. ACH presents with corneal oedema because of a tear in Descemet\u0026rsquo;s membrane (DM) and endothelium, followed by leakage of aqueous humour into the stroma. The presentation includes severe vision loss, photophobia, redness, and grey eye [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. ACH can self-heal over 2\u0026ndash;6 months, depending on the extent of DM rupture. During this process, complications may occur, such as infection, intrastromal cleft formation, perforation, corneal neovascularisation, and a greater risk of corneal rejection after keratoplasty [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the past 20 years, different treatments for ACH have been studied [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The objectives are to hasten the resolution of oedema, improve vision, or prepare for further surgery. Many studies have proposed various methods to promote oedema resorption [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. While some studies argue that the risk of perforation may occur with deep lamellar keratoplasty (DLK) in the scar after ACH healing, recent studies argue that DLK can effectively improve vision after the oedema resolves [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To the best of our knowledge, this is the first study to observe the effect of lamellar keratoplasty (LK) or DLK in healed hydrops, performed after pre-DM sutures combined with intracameral air injection.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThe data of 11 patients (11 eyes) with ACH who presented at Beijing Aier-Intech Eye Hospital between January 2016 and December 2021 were retrospectively collected. These patients, who had undergone pre-DM sutures combined with intracameral air injection in the acute stage, underwent LK once oedema subsided. Before the LK, the corneal scar was located in the central or paracentral area of the cornea, and the patients were dissatisfied with the best-corrected visual acuity (BCVA). The patients were followed up for 18.75\u0026thinsp;\u0026plusmn;\u0026thinsp;15.53 months (6\u0026ndash;60 months). This study was approved by the Institutional Review Board (BJAIER2021IRB18) of Beijing Aier-Intech Eye Hospital and followed the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients or their legal guardian(s), and LK was performed by a single surgeon.\u003c/p\u003e \u003cp\u003eThe data collected included the patient\u0026rsquo;s age, sex, diagnosis; location and extent of the oedema; central corneal thickness (CCT); size, depth, and location of scar after ACH healing; BCVA; curvature and astigmatism of corneal topography; and spherical (S) and cylindrical (CYL) power at 1, 3, and 6 months and on the last follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSurgical technique\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eLK\u003c/strong\u003e \u003cp\u003eAfter ACH healed, LK surgery was performed. Although we were as close to the DM as possible, DM was not exposed completely; thus, it was near-DLK. The corneal trephine diameter was determined by measuring the area of scar involvement. Next, the host cornea was trephined to approximately 50% of its thickness, and 80% of the corneal depth was drilled and stripped layer by layer by the blade tip. Owing to the scar, big bubbles could not be used; therefore, we used small bubbles to separate the stroma and help determine the stripping depth. Anterior chamber paracentesis reduced the intraocular pressure to avoid DM tears. In the scar, the risk of perforation is high because the stroma and DM adhere closely and must be peeled carefully from the periphery going inwards without pulling. The implant bed was then kept as thin as possible, and the use of microsurgical scissors was preferred to blades. When microperforation occurs, anterior chamber gas injection can help complete the operation because air can block the leakage of the aqueous humour.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe donor button of all patients was made into appropriately sized grafts according to the length of the patient\u0026rsquo;s visual axis. The donor button was placed on the recipient bed and sutured with 16 interrupted 10/0 nylon sutures. The patients were administered tobramycin dexamethasone (Tobrex, Alcon NV, Switzerland) eye drops four times a day and ointments once nightly for the first month after the operation and reduced gradually according to the eye condition. If the suture loosens within 3 months, it needs to be resutured, but if it loosens after 3 months, it can be removed. After 6 months, the corneal sutures were removed selectively based on corneal astigmatism.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEvaluation of corneal oedema\u003c/h3\u003e\n\u003cp\u003eThe grading standard of corneal oedema was as follows [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]: grade I, within a circle of 3 mm diameter; grade II, within circles of 3\u0026ndash;5 mm diameters; and grade III, larger than a circle of 5 mm diameter. The grading standard of corneal scar degree was as follows: grade I, not involving the pupil area; grade II, pupil area\u0026thinsp;\u0026lt;\u0026thinsp;1/2; and grade III, pupil area\u0026thinsp;\u0026ge;\u0026thinsp;1/2.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eLK was performed in 11 patients (eyes), including 10 men (90.91%) and 1 woman (9.09%), with an average age of 19.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01 years (15\u0026ndash;28 years). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e describes the pre-operational general conditions and corneal characteristics, including sex, age, the extent and grade of ACH oedema, the location and size of the scar after the oedema resolved, the time interval between LK and suture, and the changes in vision and astigmatism.\u003c/p\u003e \u003cp\u003eAll eyes had corneal scars graded II or greater, including eight eyes (72.73%) with grade III corneal scars. The average time of corneal oedema reduction was 11.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.45 days. After the oedema resolved, the degree of the corneal scar was grade II or above, involving the pupil, and six (54.55%) of the patients had a grade III scar.\u003c/p\u003e \u003cp\u003eThe average follow-up time was 15.45\u0026thinsp;\u0026plusmn;\u0026thinsp;8.54 (6\u0026ndash;30) months. The follow-up time for seven eyes was \u0026ge;\u0026thinsp;1 year. The BCVA of all patients before DLK was \u0026le;\u0026thinsp;0.3 (0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14, 0.01\u0026ndash;0.3). The average interval between the pre-DM suture and LK was 41.91\u0026thinsp;\u0026plusmn;\u0026thinsp;36.39 (6\u0026ndash;133) days (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The BCVA after corneal transplantation was improved. The BCVA at the last follow-up was 0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 (0.15\u0026ndash;0.7), of which eight eyes had BCVA\u0026thinsp;\u0026ge;\u0026thinsp;0.5. The average astigmatism of the anterior surface of corneal topography was 5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38 D, and the average CYL of optometry was \u0026minus;\u0026thinsp;4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87 D (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMicroperforation occurred in two cases, but the LK was completed successfully. The residual scar of most cases decreased over time, and vision continued to improve. In some cases where the scar was located in the pupil area, the postoperative vision also exceeded expectations. After the operation, five eyes had double anterior chambers, of which four were well attached after applying liquid between the layers, and in one eye, the double anterior chambers disappeared spontaneously.\u003c/p\u003e \u003cp\u003eThe average CCT at the last follow-up was 552.81\u0026thinsp;\u0026plusmn;\u0026thinsp;62.81 \u0026micro;m (449\u0026ndash;637 \u0026micro;m). No rejection and other complications occurred in all patients until the last follow-up (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral preoperative condition and corneal characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient no.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExtent of oedema (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGrading standard of corneal oedema\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCornea oedema resolution time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGrading standard of scar after the oedema healed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCorneal Scar range (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBCVA before keratoplasty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eTime interval between DLK and suture (d)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.53 *3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.43*2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.40*4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.67*3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.90*7.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6.55*3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.47*4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.07*2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.26*4.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.56*2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.86*2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.60*2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.68*3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.39*2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.78*5.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.57*3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.43*6.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7.57*1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.07*6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6.00*3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.80**5.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.21*2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntraoperative and postoperative data recording of pre-DM DLK\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePatient no.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMicroperforation during surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSuture pattern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c13\" namest=\"c4\"\u003e \u003cp\u003ePostoperative data\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDouble chamber after surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFollow-up (months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c13\" namest=\"c6\"\u003e \u003cp\u003eLast follow-up data\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBSCVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003ePentacam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eOptometry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCCT (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eK1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eK2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eKmean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAstig\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eCYL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e557\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e449\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e+\u0026thinsp;1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e473\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e588\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e56.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e55.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e+\u0026thinsp;4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e54.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-9.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-8.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e44.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e43.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe self-healing time for ACH is long, and conservative management does not hasten healing. The healing time of oedema in treating corneal sutures was significantly shorter than that of self-healing [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, the reducing time after corneal suture was 11.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.45 days, significantly shorter than that after conservative management. Some patients had significant regression of corneal oedema within 5days after suture placement (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Corneal oedema subsided in approximately 2 weeks in the present study, which is consistent with the results presented by Zhao et al. and Cherif et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, previous studies did not further explore the follow-up treatment after healing.\u003c/p\u003e \u003cp\u003eKeratoconus occurs in young patients, and the age onset of ACH is younger. Therefore, the long-term survival of corneal grafts is very important. For young patients with keratoconus, DLK is the first choice. However, DLK has not been considered for deep scars involving DM for many years because of the risk of perforation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Das et al. first reported a case of DLK after ACH healing. Although a scar was left in the optic axis area, the BCVA recovered to 1.0 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Anwar et al. observed 22 eyes and performed near-Descemet dissection deep antibiotic lamellar keratoplasty on the patients after the ACH healing; perforation occurred in 6 eyes, and the operation was completed through intracameral gas injection [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These studies provide valuable information regarding the feasibility of subsequent DLK.\u003c/p\u003e \u003cp\u003ePrevious studies mainly focused on DLK after self-healing of ACH. Zhao et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] reported that 65% of patients had a BCVA of 0.63 (0.2 LogMAR) or better 24 months after the operation. In the 3-year follow-up results of Anwar et al., the average BCVA was approximately 0.5, and approximately 68% of the patients had BCVA\u0026thinsp;\u0026ge;\u0026thinsp;0.5 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In our study, the average BCVA was 0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 (0.15\u0026ndash;0.8). Eight (72.73%) patients had a BCVA of 0.5 or better, while 6 (54.55%) had a BCVA of \u0026ge;\u0026thinsp;0.6. To the best of our knowledge, we are the first to observe the LK effect after pre-DM sutures. Our visual acuity results were similar to the two previous studies. Our patients had no rigid gas permeable contact lens vision correction, or the BCVA could have been better.\u003c/p\u003e \u003cp\u003eFew studies discuss the appropriateness of surgery. When the scar persists for a long time, the DM closely adheres to the stroma, increasing the difficulty of DLK and the risk of perforation. The scar also affects vision because it cannot be peeled off. Chew et al. advocated that DLK be performed no sooner than 4 months after the occurrence of hydrops because the healing process takes 4\u0026ndash;6 months to be completed [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our study, pre-DM sutures shorten the healing time of the ACH. Our results showed that LK was performed in all patients. The average interval between the pre-DM sutures and LK was 41.91\u0026thinsp;\u0026plusmn;\u0026thinsp;36.39 days (6\u0026ndash;133 days). We tried to perform LK at different times after the corneal oedema subsided. The LK time was gradually shortened from 4 months after the corneal oedema subsided. Most operations were completed in 3 weeks to 1 month. One case underwent LK 6 days after suture. A relatively good vision could be obtained in most patients. Therefore, surgery may be performed earlier, which may reduce the residual scar. One month after suturing may be a suitable interval. The corneal scar may still remain oedematous in some patients at this time, such that the residual scar may be uneven during the surgery, but it will improve with time. Nevertheless, further research on the optimal interval is needed before firm recommendations can be made.\u003c/p\u003e \u003cp\u003eHowever, because the healing of the DM rupture was not tight in the early stage, the big bubble technique could not be utilised to separate the stroma to avoid perforation. Pre-DM LK with manual stripping could be used. This method may affect vision in a few cases because of the non-uniform thickness of the recipient implant bed. This view is consistent with that of Nanavaty et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In our study, one patient\u0026rsquo;s postoperative BCVA was poor as the implant bed was thicker and more uneven (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Therefore, we used microsurgical scissors to thin the implant bed. The scar, especially in the pupil area, was surgically excised as completely as possible. Anwar et al. found that the postoperative vision with residual scar is lower than that with penetrating keratoplasty and DLK without a scar. It is believed that the location and size of the scar impact the vision to some extent [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, Zhao et al. found that the slight residual scars on the implant bed have no significant impact on the vision [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], consistent with the results of our study. We found that in the early stage of healing after keratoplasty, the stromal oedema in the residual scar area affects vision. Over time, the stromal oedema will reduce, and vision will improve (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In this study, most patients had a mild residual scar, but the average postoperative vision was 0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 (0.15\u0026ndash;0.8). Therefore, we believe that retaining a mild scar may affect vision slightly, but it has less risk and greater benefit.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFor ACH after suture of pre-DM, LK after ACH healing is an effective method to improve the vision, and the residual scar of deep stroma will not significantly affect the outcome. In our study, most patients can be performed LK in approximately 1 month. The suture of pre-DM combined with the LK can significantly shorten the healing time of the disease. This study provides a feasible method for the further treatment of ACH after suture of pre-DM.\u003c/p\u003e \u003cp\u003eThis study has limitations. A larger series with a longer follow-up period is necessary to confirm the results. In addition, further studies should be conducted to assess the timing and methods of operation after suturing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study approved by the Institutional Review Board (BJAIER2021IRB18) of Beijing Aier-Intech\u0026nbsp;Eye\u0026nbsp;Hospital and followed the tenets of the Declaration of Helsinki. Written informed consent\u0026nbsp;for participation\u0026nbsp;was obtained from all patients.\u0026nbsp;The\u0026nbsp;informed consent for all participants below the age of 16 was obtained from their parents or their legal guardian(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll study participants provided informed consent\u0026nbsp;for publication.\u0026nbsp;The informed consent of publication for all participants below the age of 16 was obtained\u0026nbsp;from their parents or their legal guardian(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Science Research Foundation of Aier Eye Hospital Group (grant number AR2104D3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All authors contributed to the study conception and design. JB and CL contributed to analysis and interpretation of data and drafted the manuscript. LZ, LL, WXS and LPH contributed to data analysis. SWL has reviewed this manuscript and given final approval. All authors commented on previous versions of the manuscript. All authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.cn) for English language editing.\u0026nbsp;\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmsler M. Some data on the problem of keratoconus[J]. Bull De La Societe Belge Dophtalmologie. 1961;129:331\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTuft SJ, Gregory WM, Buckley RJ. Acute Corneal Hydrops in Keratoconus[J]. Ophthalmology. 1994;101(10):1738\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaharana PK, Nagpal R, Sharma N. Corneal Hydrops in Keratoconus[J]. Indian J Ophthalmol. 2015;4(8):52\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer JJ, McGhee CN. Acute corneal hydrops complicated by microbial keratitis: case series reveals poor immediate and long-term prognosis. Cornea. 2016;35(7):1019\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeder RS, Wilhelmus KR, Vold SD, et al. Intrastromal clefts in keratoconus patients with hydrops. Am J Ophthalmol. 1998;126(1):9\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a-Albisua AM, Davila-Avila N, Hernandez-Quintela E, et al. Visual and Anatomic Results After Sole Full-Thickness Sutures for Acute Corneal Hydrops[J]. Cornea. 2020;39(5):661\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOteyza G, Bregliano G, Sassot I, et al. Primary surgical options for acute corneal hydrops: A review:[J]. Eur J Ophthalmol. 2022;32(2):781\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyata K, Tsuji H, Tanabe T, et al. Intracameral air injection for acute hydrops in keratoconus[J]. Am J Ophthalmol. 2002;133(6):750\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanda A, Aggarwal A, Madhavi P, et al. Management of acute corneal hydrops secondary to keratoconus with intracameral injection of sulfur hexafluoride (SF6).[J]. Cornea. 2007;26(9):1067\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasu S, Vaddavalli PK, Ramappa M, et al. Intracameral Perfluoropropane Gas in the Treatment of Acute Corneal Hydrops[J]. Ophthalmology. 2011;118(5):934\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajaraman R, Singh S, Raghavan A, et al. Efficacy and safety of intracameral perfluoropropane (C3F8) tamponade and compression sutures for the management of acute corneal hydrops.[J]. Cornea. 2009;28(3):317\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Z, Wu S, Ren W, et al. Compression sutures combined with intracameral air injection versus thermokeratoplasty for acute corneal hydrops: a prospective-randomised trial[J]. Br J Ophthalmol. 2020;105(12):1645\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYahia Ch\u0026eacute;rif H, Gueudry J, Afriat M, et al. Efficacy and safety of pre-Descemet's membrane sutures for the management of acute corneal hydrops in keratoconus[J]. Br J Ophthalmol. 2015;99(6):773\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnwar HM, Anwar M. Predescemetic dissection for healed hydrops\u0026ndash;judicious use of air and fluid.[J]. Cornea. 2011;30(12):1502\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNanavaty MA, Da Ya SM. Outcomes of deep anterior lamellar keratoplasty in keratoconic eyes with previous hydrops.[J]. Br J Ophthalmol. 2012;96:1304\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChew A, Mehta JS, Tan D. Deep lamellar keratoplasty after resolution of hydrops in keratoconus.[J]. Cornea. 2011;30:454\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Z, Li J, Zheng Q, et al. Wet-Peeling Technique of Deep Anterior Lamellar Keratoplasty with Hypotonic Water and Blunt Dissection for Healed Hydrops[J]. Cornea. 2017;36:386\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDas S, Dua N, Ramamurthy B. Deep lamellar keratoplasty in keratoconus with healed hydrops.[J]. Cornea. 2007;26(9):1156\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute corneal hydrops, Pre-Descemet’s membrane, Complications, Lamellar keratoplasty","lastPublishedDoi":"10.21203/rs.3.rs-2392446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2392446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e This study aimed to observe the effect of lamellar keratoplasty (LK) after pre-Descemet’s membrane (pre-DM) suture healing of acute corneal hydrops (ACH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In a retrospective noncomparative case series, 11 patients (11 eyes) with ACH, who underwent pre-DM suture combined with intracameral air injection in the acute stage, underwent LK when the oedema subsided. During surgery, the diseased cornea was stripped layer by layer, and a mild scar in the deep stroma occasionally remained. The age, sex, diagnosis, scope of acute corneal oedema, size and location of scar after oedema healing, operation interval, postoperative best-corrected visual acuity (BCVA), astigmatism, and intraoperative and postoperative complications were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The average follow-up time was 15.45 ± 8.54 months (6–30 months). The average time from corneal suture to LK was 41.91 ± 36.39 days. After LK, the BCVA was 0.52 ± 0.18 (0.15–0.8), astigmatism on the front surface of corneal topography was 5.63 ± 1.28 D, and apparent optometry CYL was -4.50 ± 1.87 D. The central corneal thickness was 552.81 ± 62.81 μm (449–637 μm). Microperforation occurred in two cases. No other complications occurred in any patients until the last follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e LK can be performed earlier after the pre-DM suture of ACH. The combination of the two can shorten the overall course of the disease, significantly improve vision, and avoid the complications of penetrating keratoplasty.\u003c/p\u003e","manuscriptTitle":"Effect of lamellar keratoplasty after pre-Descemet’s membrane suture healing of acute corneal hydrops","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-11 15:33:14","doi":"10.21203/rs.3.rs-2392446/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"946db3c1-5da0-412a-a511-cdaa3349cd09","owner":[],"postedDate":"January 11th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-06-05T06:44:43+00:00","versionOfRecord":[],"versionCreatedAt":"2023-01-11 15:33:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2392446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2392446","identity":"rs-2392446","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}