Anterior Segment Oct–Guided Partial-Thickness Compression Sutures For Acute Corneal Hydrops

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR055 | Type: Case Report | DOI: 10.82333/d8bd-ve57

Authors: Dr Lauren Olivia Farr* ¹ , Dr Ahmed Shalid ¹ , Mr Abhinav Loomba ¹ , Mr Sid Goel ¹ , Dr Ashish Khindria ²

¹Ophthalmology,Hull University Teaching Hospitals NHS Trust,Hull,United Kingdom, ²Ophthalmology,University Hospitals Birmingham NHS Foundation Trust,Birmingham,United Kingdom

Purpose

To describe the use of anterior segment optical coherence tomography (AS-OCT)–guided partial-thickness compression sutures for the management of acute corneal hydrops secondary to advanced keratoconus, highlighting their role in enabling accurate surgical planning and effective corneal recovery.

Setting

Tertiary referral centre specialising in advanced corneal disease and complex keratoconus-related complications.

Report of case

A 47-year-old woman with cerebral palsy and learning difficulties presented with progressive bilateral visual loss. Clinical examination was severely limited, with visual acuity reduced to counting fingers in both eyes and dense corneal oedema precluding reliable slit-lamp assessment. The right eye was identified as the acutely affected eye.

Anterior segment OCT demonstrated a focal Descemet’s membrane (DM) rupture with associated stromal oedema in the right eye, consistent with acute corneal hydrops in advanced keratoconus. Importantly, AS-OCT enabled precise localisation and orientation of the DM tear, which was essential for surgical planning in the absence of adequate clinical visualisation.

Urgent surgical management was undertaken using partial-thickness compression sutures placed at a controlled stromal depth and oriented according to AS-OCT findings to oppose the DM break, combined with adjunctive intracameral gas injection to facilitate reattachment. Postoperatively, corneal oedema resolved progressively with residual stromal scarring. Best-corrected visual acuity in the right eye improved to 6/60, providing meaningful functional visual recovery.

Conclusion/Take home message

Partial-thickness compression sutures, when guided by anterior segment OCT, provide a targeted and effective surgical approach for acute corneal hydrops, enabling accurate suture placement, rapid corneal deturgescence, and earlier visual rehabilitation. This combined technique is particularly valuable in patients with neurological or cognitive impairment, where slit-lamp examination is limited and prolonged conservative management may be impractical. The case supports the integration of AS-OCT-guided partial-thickness suturing as a practical option in the surgical management of severe hydrops.