Kumar Deepak, Bari Aafreen, Jhanji Vishal, Sharma Namrata, Agarwal Tushar
Ophthalmology, All India Institute of Medical Sciences, New Delhi, IND.
Cornea, Cataract, and External Disease Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.
Cureus. 2025 Jan 6;17(1):e77049. doi: 10.7759/cureus.77049. eCollection 2025 Jan.
An 18-year-old boy presented with blurred visual acuity in the left eye for three days associated with mild pain and photophobia. On examination, he had diffuse corneal stromal edema. Anterior segment optical coherence tomography (AS-OCT) revealed stromal edema with a large hypodense fluid pocket in the posterior stroma. A diagnosis of acute hydrops with an intrastromal cleft in the left eye was made, and he was planned for intracameral gas injection. Intraoperatively, microscope-integrated OCT (Mi-OCT)-guided intracameral isoexpansile sulphur hexafluoride(SF6) was injected ensuring an 80% fill of the anterior chamber. Mi-OCT-assisted venting incision with drainage of stromal fluid clefts was done. On the first postoperative day, the fluid pocket and stromal edema resolved completely. At six weeks' follow-up, the central cornea remained clear with the formation of a paracentral scar. Thus, intracameral gas combined with stromal cleft drainage appears to be a highly effective management option for acute hydrops with a single large stromal fluid cleft. Intraoperative OCT (Mi-OCT) can guide real-time drainage of intrastromal fluid clefts, facilitating the closure of focal Descemet's membrane (DM) defects and enabling early visual rehabilitation, as demonstrated in this case as early as one-day postprocedure.
一名18岁男孩因左眼视力模糊三天前来就诊，伴有轻度疼痛和畏光。检查发现，他有弥漫性角膜基质水肿。眼前节光学相干断层扫描（AS-OCT）显示基质水肿，后基质有一个大的低密度液腔。诊断为左眼急性角膜水肿伴基质内裂，计划行前房内气体注射。术中，在显微镜集成光学相干断层扫描（Mi-OCT）引导下向前房内注射等膨胀性六氟化硫（SF6），确保前房填充80%。进行Mi-OCT辅助排气切口并引流基质液裂。术后第一天，液腔和基质水肿完全消退。在六周的随访中，中央角膜保持清晰，形成旁中心瘢痕。因此，前房内气体联合基质裂引流似乎是治疗伴有单个大基质液裂的急性角膜水肿的一种非常有效的治疗选择。术中光学相干断层扫描（Mi-OCT）可以引导基质内液裂的实时引流，促进局限性后弹力层（DM）缺损的闭合，并实现早期视力恢复，如本病例所示，术后一天即可实现。
