Management of Acute Corneal Hydrops Using Compression Sutures and Intracameral Air Injection.

BACKGROUND Acute corneal hydrops, a rare complication of keratoconus, is characterized by sudden onset of corneal stroma edema. It typically manifests as an acute decrease in visual acuity, accompanied by pain and photophobia. Prompt recognition and interventions are critical for effective resolution of hydrops and prevention of corneal vascularization. Herein, we present a case of a patient with keratoconus who developed corneal hydrops, successfully managed using full-thickness compression sutures and intracameral air injection. CASE REPORT A woman in her early 30s, with a history of keratoconus, presented with symptoms of acute hydrops in her left eye. On presentation, best corrected visual acuity was hand motion. Slit-lamp examination revealed marked corneal edema with multiple stromal clefts. The decision was made to perform full-thickness compression sutures combined with intracameral air injection to expedite edema resolution and prevent neovascularization. Three full-thickness sutures were placed across Descemet membrane breaks, and an air bubble was left, filling 50% of the anterior chamber. At 3-month follow-up, a clear, compact cornea was noted, with no evidence of vascularization. The patient was scheduled for penetrating keratoplasty for visual rehabilitation. CONCLUSIONS The combination of full-thickness compression sutures and intracameral air seems to be an effective and safe method for preventing corneal angiogenesis following hydrops. As corneal scaring is often an inevitable complication of acute corneal hydrops, keratoplasty is necessary for improving visual acuity. Hence, the prevention of corneal vascularization should be the major aim in the management of corneal hydrops to ensure successful keratoplasty.