Deep Corneal Sutures Alone Oriented By Preoperative Corneal Oct During The Surgical Management Of Corneal Hydrops

Published 2023 - 41st Congress of the ESCRS

Reference: FP06.05 | Type: Free paper | DOI: 10.82333/tgya-e271

Authors: Moatez Billah Mekki* ¹ , SAID YAHIAOUI ¹ , OKBA TITAH ¹ , AMINE TAIBI ¹ , Karim Nassim Haddoum ² , Mhamed Ouzzani ³ , Adel Oulebsir ¹

¹Ibn Al Haythem Center,Algiers,Algeria, ²Ibn Al Haythem Center,Algiers,Algeria;Chateaudun Hospital,Châteaudun,France, ³Ibn Al Haythem Center,Algiers,Algeria;Laboratoire de physique et de couches minces,Université Oran1,Oran,Algeria

Purpose

To show the interest of pre-operative corneal OCT to orient deep corneal sutures in case of acute corneal hydrops.

Setting

Ibn Al Haythem Center

Methods

Prospective study of 22 consecutive eyes of 22 patients with acute corneal hydrops. Preop corneal OCT was centered by the hydrops opacity. The orientation of the OCT section showing the best endothelium break or diastasis is used as a landmark direction to orient the deep corneal sutures that are performed under topical anesthesia in all cases except for 4 cases with Down syndrome who needed general anesthesia. Sutures are tied tightly under tension. No air or gas injections into the anterior chamber were done. OCT central corneal pachymetry (CCP) was measured before and within the first week after surgery. Success is defined by a recovery of corneal transparency with a VA ≥ 0.5 with a scleral lens at 1 month postop.

Results

The mean age was (22.71 +/- 6.21 years) in the 16 keratoconus (KK) patients versus (37.86 +/- 8.61 years) in the 6 pellucid marginal degeneration (PMD) patients (p < 10-3). According to OCT findings and thus the main axis of the endothelium Descemet break or diastasis, the orientation of the sutures was horizontal in 14 eyes (64%) and oblique in 8 eyes (36%). 10 eyes never worn contact lens before the hydrops, 10 eyes worn scleral lens, and 2 RGPL. The mean OCT CCP dropped from (1195 +/- 604 µ) preop to (593 +/- 362 µ) postop (p <0.001). 19 eyes (86%) healed in less than a week. Failure was seen in 3 eyes (14%).

Conclusions

The use of preoperative corneal OCT to orient the deep corneal sutures in the case of corneal hydrops is mandatory to improve the outcome and reduce the recovery time.

Hydrops may occur later in eyes with PMD compared to those with KK.

Wearing contact lenses is not a risk factor for the occurrence of hydrops.