Pneumatic Descemetopexy In Acute Corneal Hydrops

Acute corneal hydrops is a rare complication of keratoconus due to a rupture of the Descemet membrane- Dua layer complex, resulting in the imbalance of stromal homeostasis and the formation of corneal oedema. Recent advances in corneal imaging techniques improved our ability to understand and treat this condition using surgical descemetopexy with gaz tamponade as an effective method to control symptoms and shorten recovery time. The aim of our study is to describe treatment modalities and outcomes in acute hydrops in keratoconic eyes.

20th August Hospital, CHU Ibn Rochd University Hospital, Casablanca, Morocco.

We led a retrospective observational study extending from January 2015 to October 2023 at the Ophthalmology department at the 20^th August 1953 University Hospital in Casablanca. We described demographic, clinical and paraclinical features, as well as treatment and evolution patterns of these patients. Data was collected using an exploitation sheet and results were rendered statistically. The study included all admitted patients with acute corneal hydrops, and the exclusion criteria was insufficient data. Variables used were demographics (age, sex), medical history, clinical examination, anterior segment OCT results, corneal topography and keratometry, treatment regimen and evolution patterns.

Among 24 cases, 90% had vision loss, 16% photophobia, and 66% had intense pain. The mean initial BCVA was HM and 33% had corneal edema. The corneal hydrops was grade I in 20%, grade II in 50%, and grade III in 30% of cases. Keratoconus was stage 4 in 81%and stage 3 in 19% of cases.

Conservative management was prescribed in 17% of cases, while surgical management in 83% cases consisted of intracameral gaz injection of SF6 in 85%, C2F6 in 12%, and 3% had air injection, along with compression sutures in 60%. One patient had an immediate post-op pupillary block, while 70% had regression of pain, 30% had corneal oedema regression, 40% had a differed  penetrating keratoplasty and the mean final BCVA was at counting fingers.

Acute hydrops in keratoconus is relatively uncommon, however, it can cause significant morbidity in young patients as corneal opacities and scarring are inevitable, and most patients will require corneal transplantation for visual rehabilitation. The development of new corneal imaging techniques has helped better understand its pathogenesis through the involvement of the Dua layer. This may improve surgical treatment outcomes, however,  being a rare entity, larger prospective studies are needed to assess treatment options for this multifaceted disease process.