Intracameral C2f6 Gas Injection For Acute Corneal Hydrops In A Pediatric Patient: An 18-Month Follow-Up

To report the clinical course and outcomes of intracameral C2F6 gas injection in the management of acute corneal hydrops in a pediatric patient with underlying keratoconus.

Cornea unit, Department of Ophthalmology, Hillel Yaffe Medical Center, Hadera, Israel.

A 14-year-old female presented with an acute onset of blurred vision, ocular pain, redness, and photophobia in her right eye. Best-corrected visual acuity (BCVA) was reduced to hand motion. Slit-lamp examination revealed central corneal edema consistent with acute corneal hydrops. Corneal tomography of the contralateral eye demonstrated characteristic features of keratoconus. Initial conservative management for two weeks led to worsening symptoms, prompting intervention with intracameral perfluoroethane (C2F6) gas injection. This minimally invasive procedure aims to tamponade the Descemet membrane tear, creating a barrier to prevent further aqueous entry into the stroma and facilitating resolution of the acute episode while reducing the risk of visually significant scarring.

Postoperatively, the patient developed acute reverse pupillary block despite adequate pupillary dilation and appropriate positioning. This complication was promptly identified and successfully managed by reducing the intracameral gas volume, with no further sequelae. At one-week post-procedure, there was a marked improvement in both subjective symptoms and objective clinical findings, with rapid resolution of corneal hydrops. At 18 months follow-up, residual inferior paracentral corneal scarring was noted, with a BCVA of 6/15 with scleral contact lenses.

Intracameral gas injection proved to be a safe and effective intervention for acute corneal hydrops in this pediatric case, leading to rapid resolution with minimal residual scarring and favorable visual outcomes. This approach may offer a better visual prognosis compared to conservative management. However, literature on intracameral gas injection in the pediatric keratoconus population remains limited, highlighting the need for further studies. We present slit-lamp and anterior segment OCT imaging before and after the procedure, with long-term follow-up findings over 18 months.