Compressive Pre-Descemet Corneal Suturing With Intracameral Air For Persistent Corneal Hydrops Secondary To Keratoconus

To report the clinical and visual outcomes of compressive pre-Descemet corneal suturing with intracameral air in a case of persistent corneal hydrops secondary to keratoconus.

Tertiary referral center specializing in cornea and ocular surface disease.

A 20-year-old male presented with acute corneal hydrops secondary to keratoconus and was initially managed with standard medical therapy. Despite conservative treatment, marked stromal edema and severe visual impairment persisted for six months, with visual acuity deteriorating from counting fingers to hand motion.

Given the absence of spontaneous resolution and after reviewing available surgical options described in the literature, targeted compressive pre-Descemet suturing was performed. Four interrupted 10-0 nylon sutures were placed over the presumed area of Descemet membrane rupture, combined with intracameral air to facilitate reattachment and prevent pupillary block.

Postoperatively, progressive resolution of corneal edema was observed. At one month, visual acuity improved to 20/150. By four months, uncorrected visual acuity reached 20/50 and remained stable at one-year follow-up. Serial topographic imaging demonstrated significant corneal regularization, and keratoplasty was avoided.

In persistent corneal hydrops unresponsive to medical therapy, compressive pre-Descemet suturing represents a safe and effective surgical alternative that may restore corneal clarity, improve functional vision, and prevent the need for keratoplasty. Even when intervention is delayed, substantial functional visual improvement can be achieved.