Successful Management Of Acute Corneal Hydrops In Children With Intracameral C3f8 Injection A Case Series

Hydrops in pediatric patients with keratoconus using intracameral perfluoropropane C3F8 gas injection. Acute corneal hydrops is a severe complication of advanced corneal ectasia characterized by a spontaneous rupture of Descemet’s membrane, which allows aqueous humor to enter the corneal stroma. In the pediatric population, this condition is particularly concerning due to the heightened risk of amblyopia and permanent visual impairment. This case series aims to highlight the potential of this minimally invasive approach as a safe and effective therapeutic option to promote rapid resolution and favorable anatomic outcomes.

The clinical cases and surgical procedures described in this report were managed at the Clínica Oftalmológica Colsubsidio in Bogotá, D.C., Colombia.  

This case series describes three pediatric patients presenting with acute ocular pain, photophobia, and decreased vision. The cohort included two males (9 and 15 years) and one female (17 years) with known keratoconus and a history of frequent eye rubbing. Diagnosis was confirmed via slit-lamp exam and anterior segment optical coherence tomography (AS-OCT), which identified stromal edema, corneal thinning, and Descemet’s membrane rupture. Each patient underwent urgent intracameral injection of 30% C3F8 gas. Postoperatively, pharmacologic mydriasis was induced to prevent pupillary block, and patients maintained a strict supine position to facilitate membrane reattachment

All patients showed significant anatomical and symptomatic improvement within one month. Follow-up AS-OCT confirmed near-complete reattachment of Descemet’s membrane and a significant reduction in corneal edema. The 9-year-old male achieved successful recovery despite high initial perforation risk. The 15-year-old male demonstrated improved corneal clarity and favorable anatomical outcomes. The 17-year-old female, initially presenting with light perception, showed gradual visual improvement and corneal stabilization. No intraoperative or postoperative complications, such as pupillary block, inflammation, or elevated intraocular pressure, were observed in any case. 

Intracameral injection of C3F8 gas appears to be a safe and effective treatment for acute corneal hydrops in pediatric patients, promoting more rapid resolution than traditional conservative management. By providing a sustained mechanical tamponade, the gas accelerates the reattachment of Descemet’s membrane and minimizes stromal scarring. This early surgical intervention is critical in children to preserve visual development, reduce the risk of amblyopia, and avoid the need for urgent, high-risk keratoplasty. Ultimately, this approach preserves the structural integrity of the cornea and serves as a bridge to future stabilization therapies such as corneal cross-linking.