En Face Oct Of Descemet Dua Complex: New Precision Paradigm In Acute Corneal Hydrops Management
Published 2026 - 44th Congress of the ESCRS
Reference: FP18.09 | Type: Free paper | DOI: 10.82333/s1kj-0668
Authors: Dr Moatez Billah Mekki* 1 , Dr Said Yahiaoui 1 , Dr Okba Titah 1 , Dr Amine Taibi 1 , Haddoum Karim Nassim 1 , Dr Youcef Ould Bouamama 1 , Mr Adel Oulebsir 1 , A/Prof. Mhamed Ouzzani 2 , Mr Walid Draoui 1
1Ibn Al Haythem Center,Algiers,Algeria, 2University Oran 1,Oran,Algeria
Purpose
To evaluate the impact of high-resolution Swept-Source OCT (SS-OCT) with 3D "en face" reconstruction on the surgical management of acute corneal hydrops, specifically focusing on how precise visualization of the Descemet-Dua complex rupture allows for targeted "oriented" deep compressive sutures.
Setting
Ibn Al Haythem Center, Algiers
Methods
This study reviews clinical cases of acute corneal hydrops managed with the TowardPi Yalkaid SS-OCT (1060 nm,100 kHz). Pre-operative planning utilized 3D "en face" imaging with a specific 70 \micron slab starting from the endothelium and extending into the deep stroma. This allowed for the exact localization, length measurement, and morphological assessment (linear, horseshoe, or complex shapes) of the Descemet-Dua complex rupture, even through massive edema. Deep 10-0 monofilament compressive sutures were then surgically placed strictly perpendicular to the exact topography and orientation of the rupture as mapped by the OCT.
Results
The SS-OCT successfully visualized the rupture in 100% of cases, regardless of the severity of the hydrops. Compared to traditional empirical suturing, "oriented" sutures guided by pre-operative topography led to a more rapid and predictable resolution of stromal edema. Targeted compression achieved immediate apposition of the Descemet-Dua gap, significantly reducing the duration of stromal deturgescence. This precision-guided approach minimized secondary inflammation and prevented corneal neovascularization. All patients, including those with "huge" hydrops, achieved a compact and transparent cornea within 1 week, facilitating early visual rehabilitation.
Conclusions
Moving from empirical to precision-guided surgery transforms the prognosis of acute hydrops. The use of SS-OCT 3D "en face" slab of the Descemet-Dua complex allows for "oriented" suturing that ensures optimal anatomical apposition. This approach proves that with precise pre-operative mapping, acute corneal hydrops can be resolved quickly and effectively, protecting the cornea for future optical rehabilitation.