Intraoperative Oct-Guided Pneumodescemetopexy And Corneal Compression Sutures For Extensive Acute Corneal Hydrops

To highlight the roles of intraoperative optical coherence tomography (iOCT) in managing acute corneal hydrops (ACH) and outcomes of iOCT-guided pneumodescemetopexy and corneal compression sutures. 

This study was conducted in Birmingham and Midland Eye Centre, UK, between Aug 2023 and May 2025. 

This was a retrospective, consecutive, interventional case series of patients with keratoconus who presented with significant ACH and underwent iOCT-guided pneumodescemetopexy (with 18% sulfur hexafluoride gas) and compression sutures 

Five patients were included; mean age was 32.3±6.6 years old. The mean follow-up duration was 16.3±5.6 months. At presentation, the mean corrected-distance-visual-acuity (CDVA) was 1.90±0.67 logMAR, central corneal thickness (CCT) was 1187.6±372.6μm. The surgery successfully achieved complete PDL/DM attachment in all cases, with a mean time from surgery to Acute Hydrops resolution of 17.8±8.0 days. iOCT successfully visualized the area of PDL/DM break/detachment, revealed the involvement of PDL (evidenced by a persistent taut type 1 DM detachment after gas tamponade), and guided the placement of compression sutures. Compared to preoperative, there was a significant improvement in the mean CDVA (0.52±0.32 logMAR; p=0.014) at last follow-up.

This study demonstrated a favorable outcome of iOCT-guided pneumodescemetopexy and corneal compression sutures. iOCT revealed the involvement of PDL in ACH and provided plausible explanations why pneumodescemetopexy alone is not adequate for managing significant ACH in certain cases.