Management of Acute Corneal Hydrops Secondary to Keratoconus With Intracameral Injection of Sulfur Hexafluoride (SF6)

Panda, Anita; Aggarwal, Abhinav; Madhavi, P; Wagh, Vijay B; Dada, Tanuj; Kumar, Aman; Mohan, Shalini

doi:10.1097/ico.0b013e31805444ba

Cited by 59 publications

(44 citation statements)

References 10 publications

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“…39 Various studies have shown a significantly faster resolution time with use of these agents as compared with conventional therapy in acute hydrops with keratoconus as well as a few case reports in eyes of kerotoglobus. 36,[40][41] A study by Basu et al 41 found that the resolution time did not show much difference between conventional and intracameral perfluoropropane treatment in cases of pellucid marginal degeneration and keratoglobus. They felt that this may have been due to location of breaks in these cases as well as the usually larger, more extensive breaks associated with keratoglobus.…”

Section: Treatmentmentioning

confidence: 99%

“…Use of air, sulphur hexafluoride, and perfluoropropane has been described. [36][37][38][39][40][41] The gas is thought to act as a mechanical barrier to fluid entry into the corneal stroma, as well as a tamponading agent in re-opposing the rolled, detached edges of the Descemet's tear. This is theoretically felt to aid in endothelial migration across the tear.…”

Section: Treatmentmentioning

confidence: 99%

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Keratoglobus

Wallang

Das²

2013

Eye

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Keratoglobus is a rare noninflammatory corneal thinning disorder characterised by generalised thinning and globular protrusion of the cornea. It was first described as a separate clinical entity by Verrey in 1947. Both congenital and acquired forms have been shown to occur, and may be associated with various other ocular and systemic syndromes including the connective tissue disorders. Similarities have been found with other noninflammatory thinning disorders like keratoconus that has given rise to hypotheses about the aetiopathogenesis. However, the exact genetics and pathogenesis are still unclear. Clinical presentation is characterised by progressive diminution resulting from irregular corneal topography with increased corneal fragility due to extreme thinning. Conservative and surgical management for visual rehabilitation and improved tectonic stability have been described, but remains challenging. In the absence of a definitive standard procedure for management of this disorder, various surgical procedures have been attempted in order to overcome the difficulties. This article reviews the aetiological factors, differential diagnosis, histopathology, and management options of keratoglobus.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Keratoglobus

Wallang

Das²

2013

Eye

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“…Conventional treatment includes bandage contact lens, topical hypertonic saline and cycloplegics [3]. More invasive is the use of intracameral gas to tamponade the detached descemet's membrane to the posterior surface of the corneal stroma [4] [5]. Regarding the surgical management of keratoglobus, no golden standard has been defined.…”

Section: Discussionmentioning

confidence: 99%

Large Penetrating Keratoplasty in the Management of Keratoglobus: A Case Report

Papaioannou¹,

Papathanassiou²

2016

OJOph

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Background: Keratoglobus is a rare noninflammatory corneal disorder characterized by diffuse corneal thinning and globular protrusion of the cornea. Surgical management of keratoglobus is challenging and the standard method has not yet been defined. Aim: To present the role of large penetrating keratoplasty (PK) in the management of keratoglobus. Case Presentation: A 29-year-old male patient with bilateral keratoglobus presented with acute corneal hydrops in his right eye following extensive Descemet's membrane rupture, with a visual acuity in this eye limited to hand movement. Peripheral cornea was extremely thin and blue sclera was present. Acute hydrops was managed conservatively at this stage and two months later large PK was performed in the right eye using 9.5 mm diameter graft over a 9 mm patient's cornea trephination. Minor aqueous leakage was seen on the first postoperative day, managed with 2 more interrupted 10.0 nylon sutures. No further complications were noticed and postoperative course was uneventful. Fifteen months postoperatively the graft was clear and best corrected visual acuity was 20/60. Conclusions: Large penetrating keratoplasty has an important role in the management of keratoglobus, in cases where peripheral tuck-in lamellar keratoplasty or epikeratoplasty present serious intraoperative difficulties in host lamellar dissection and in stabilizing the graft due to extensive peripheral corneal and scleral thinning.

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“…1 Conventionally, acute hydrops is treated medically with topical antibiotic, hypertonic saline, cycloplegic with or without a bandage contact lens. However, there is emerging evidence suggesting that an earlier resolution of corneal oedema could be facilitated by intracameral injection of air, 2 sulphur hexafluoride (SF 6 ) 3,4 and perfluoropropane (C 3 F 8 ) gas. [5][6][7] The proposed mechanism is that the intracameral air or gas acts as a mechanical tamponade, helping the apposition of the Descemet's membrane and creating a barrier to prevent the entry of aqueous into the cornea.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, the short-acting property of intracameral air or SF 6 gas injection can lead to premature disappearance of the gas resulting in inadequate treatment of the acute hydrops. [2][3][4] This means that additional intracameral injection is required to maintain its tamponading action.…”

Section: Introductionmentioning

confidence: 99%