Management Of Severe Acute Hydropsis With Modified Sutures And Autologous Plasma: A Case Report

The objective of this study is to report the surgical management of a case of severe acute hydrops in a child, using modified corneal sutures and autologous plasma and its results.

Acute corneal hydrops is a rare complication related to corneal ectasia, causing corneal edema due to rupture in the Descemet layer and endothelium. It occurs in about 0.2 to 2.8% of keratoconus patients. It occurs mainly between 20 and 40 years old, with male sex being a risk factor in addition to previous atopic diseases, and rubbing the eyes. Clinical treatment is the choice in most cases, but surgical therapy with compression sutures has been shown to be effective in some patients. 

A 10-year-old male autistic patient with no previous ophthalmological history sought emergency care for his eyes, complaining of a white spot in the right eye (RE) associated with photophobia. The ophthalmological examination revealed that the patient was uncooperative and it was not possible to assess his visual acuity. Biomicroscopy of the RE showed hyperemic conjunctiva, cornea with central hydrops and significant thinning, and the left eye (LE) showed hyperemic conjunctiva, gelatinous limbus, and transparent cornea. Clinical treatment with timolol, prednisolone, and sodium hyaluronate was prescribed in the RE. After 5 days of follow-up, with no significant improvement, surgical intervention was indicated in the RE. A 50-60% thick corneal suture was performed with 10-0 nylon in an infinity format, associated with horizontal and vertical sutures. An air bubble was placed in 30% of the anterior chamber. In addition, autologous plasma was injected into the corneal stroma. On the first postoperative day, the patient was pain-free. Biomicroscopy showed significant improvement in corneal edema, well-positioned and firm sutures, an air bubble in 10% of the anterior chamber, and autologous plasma in the perilesional stroma. The patient is being monitored in the cornea department to schedule suture removal.

It is concluded that surgical management with modified compression sutures and autologous plasma are new modalities used in the management of severe acute hydrops, with good results and rapid resolution of edema, when compared with clinical treatment and traditional full-thickness sutures.