MANAGEMENT OF ACUTE CORNEAL HYDROPS WITH FULL-THICKNESS SUTURING, A CASE SERIES
Published 2022
- 26th ESCRS Winter Meeting
Reference: CR18
| Type: Cornea Day Case Presentations
| DOI:
10.82333/p9pc-3f46
Authors:
Zahra Ashena* 1
, Ritika Mukhija 2
, Mayank Nanavaty 2
1OPhthalmology,BHR University Hospital Trust,London,United Kingdom, 2OPhthalmology,Sussex Eye Hospital,Brighton,United Kingdom
Acute corneal hydrops is a painful and visually debilitating complication of keratoconus. Interventions like intracameral air or gas injection with or without full-thickness compressive suture, pre-Descemet membrane suturing, and OCT-guided drainage of intra-stromal fluid have been introduced to accelerate the corneal oedema resolution and hasten visual recovery. We describe the clinical outcome of full-thickness corneal suturing as a solo treatment in management of acute corneal hydrops.
Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
Our series include five known keratoconus patients, consisting of four male and one female between 20 and 41 years of age, who presented with acute symptoms of unilateral ocular pain, blurred vision, photosensitivity and epiphora for 3 to 8 days. Visual acuity at presentation was counting fingers in two patients and hand movement in three patients. Conservative management with lubricants, topical antibiotics, and sodium chloride 5% eye drops started in the eye casualty. Two to five days from their presentation, the procedure was carried out in the theatre: a small air bubble was injected to the anterior chamber, which revealed the Descemet break/s within 10 minutes. This technique was particularly helpful in cases with extensive oedema, where the anterior segment OCT failed to demonstrate the Descemet break. This was followed by placing 3 to 6 full-thickness interrupted 10-0 nylon corneal sutures perpendicular to the Descemet break/s. The air bubble was removed at the end of the procedure. A complete resolution of corneal oedema and ocular discomfort was noticed within 10 days in four patients and 8 weeks in one atopic patient, who presented with extensive stromal oedema secondary to a large Descemet break and a corneal thickness of 1493 µ. Corneal sutures were removed 8 to 10 weeks from the procedure. Following treatment, the mean apex pachymetry reduced from 1225±215µ to 443±56µ and best corrected visual acuity (using rigid gas permeable contact lenses), was like pre-hydrops vision in four patients, and reduced by one line in the atopic patient whose visual axis was remarkably involved. None of the patients developed any complications.
Full-thickness corneal suturing perpendicular to the Descemet break as a solo treatment is a safe and efficient intervention to reduce the duration of morbidity and the risk of significant corneal scarring in the setting of acute corneal hydrops, and subsequently postpones the need for keratoplasty in this group of patients.