Intrastromal fluid drainage with air tamponade: anterior segment optical coherence tomography guided technique for the management of acute corneal hydrops

Abstract

AimsTo describe a new technique of corneal stab incision with intracameral air injection for management of patients with acute corneal hydrops. Methods Five patients with acute corneal hydrops with large Descemet's membrane (DM) detachment and multiple stromal clefts underwent the procedure. The technique entailed anterior segment optical coherence tomography guided intrastromal fluid drainage through multiple corneal stromal venting incisions along with anterior chamber air tamponade. The time taken for the DM to reattach, resolution of corneal oedema and the best-corrected visual acuity (BCVA) were assessed postoperatively. Results Five patients (age range, 10-25 years) with large DM detachment underwent the procedure. The presenting visual acuity varied from hand motions close to face to 1/60. No intraoperative complications were encountered. The DM attached on first postoperative day in four out of five cases. The corneal oedema resolved over 2-3 weeks in all cases. Repeat air injection was not required in any of the cases. All patients had a final BCVA of ≥3/60 with two of them achieving a BCVA of ≥6/24 at three months postoperatively. Conclusions The technique of intrastromal drainage of fluid combined with air tamponade can be effectively used as a treatment modality for the management of severe cases of acute corneal hydrops.

Efficacy and safety of pre-Descemet's membrane sutures for the management of acute corneal hydrops in keratoconus

“…This conventional medical management for acute corneal hydrops is giving way to newer interventional treatment modalities in keratoconus as evidenced by a few available recent reports. Intracameral injection of air,8 SF6,9 C3 F8,10 12 intrastromal fluid drainage with air tamponade15 and tissue glue16 has been reported earlier in the management of acute hydrops. Injection of air or gas into the anterior chamber may accelerate resorption of the oedema.…”

Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment

“…It has been a useful tool for guiding anterior segment procedures such as cases of acute corneal hydrops managed with corneal stab incisions and intracameral air injection 16. Its use has been evaluated in lamellar procedures including Descemet's stripping automated endothelial keratoplasty to assess attachment of donor lenticule and the interface changes 17 18.…”

Management of advanced corneal ectasias

“…It is a useful postoperative tool for evaluating corneal graft, graft host junction and graft interface 25. ASOCT is also useful for the diagnosis and management of complications such as corneal hydrops 26 27…”

“…However persistent oedema can cause complications such as corneal neovascularisation, infection and corneal perforation. Surgical intervention is often performed to shorten the duration of the disease 1 27. Intracameral injection of air/isoexpansile gases is the most commonly performed procedure.…”

“…Intracameral injection of air/isoexpansile gases is the most commonly performed procedure. In the presence of a large DM detachment or stromal clefts, ASOCT guided intrastromal drainage with stab incisions, compressive sutures and even penetrating keratoplasty may have to be performed 1 27…”