Corneal hydrops: diagnosis and treatment

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Abstract


Acute corneal hydrops is a pathological condition which clinically presents by marked corneal edema developing due to a break in Descemet’s membrane.

Background. To analyze the results of diagnosis and treatment in patients with acute corneal hydrops.

Materials and methods. 42 patients (47 eyes) suffering from acute corneal hydrops were included in the study. This condition appeared on both eyes simultaneously or sequentially in 5 patients. Mean age was 28.7 ± 10.1 years (from 19 to 54 years), 31 men, 11 women. In case of complications or inefficacy of medical therapy surgical procedures were performed: 10% gas (C3F8, SF6) injection into the anterior chamber, amniotic membrane transplantation, partial lamellar keratoplasty, DALK, PKP.

Results. Duration of corneal ectasia before acute hydrops occurrence was 12.6 ± 4.6 years. Disease was not diagnosed before in 11.9%. Corneal thickness varied from 692 ± 98 µm in focal hydrops to 1200 ± 220 µm in total hydrops. Area of edema, height of Descemet detachment and gap between break margins were significantly above in cases of subtotal and total hydrops compared with focal and partial hydrops (χ2, p < 0,001). Injection of 10% gas (C3F8, SF6) in the anterior chamber allowed to significantly accelerating the resolution of this condition in cases of subtotal and total hydrops.

Conclusion. Analysis of this case series showed the feasibility of a differentiated approach in the treatment of acute corneal hydrops depending on its severity.


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About the authors

Galina V. Sitnik

State Educational Establishment “Belarusian medical academy of postgraduate education”

Author for correspondence.
Email: sitnik_halina@mail.ru
ORCID iD: 0000-0003-4675-9963

Belarus, Minsk

PhD, Associate Professor of Ophthalmology Chair

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Acute corneal hydrops: а – local; b – partial; c – subtotal; d – total

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2.
Fig. 2. OCT-image in acute local hydrops in keratoconus: break of Descemet membrane showed by arrow, gap between break margins, intracorneal cleft and cystoid cavity

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3.
Fig. 3. Acute corneal hydrops in pellucid marginal degeneration: а – anterior segment, area of cystoid cavities in cornea located near the limbus showed by arrow; b – OCT-image in High Resolution Corneal mode, break of Descemet membrane and gap between margins showed by arrow, low Descemet detachment, cystoid cavities in corneal stroma

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4.
Fig. 4. Complications of corneal hydrops: а – corneal ulcer; b – descemetocele; c – large descemetocele with microperforation, and total corneal neovascularization

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5.
Fig. 5. Injection of 10% gas-air mixture into the anterior chamber in acute corneal hydrops: а – partial hydrops; b – gas bubble in the anterior chamber; c – anterior segment of the eye on Day 1 after gas injection, area of edema significantly decreased, subepithelial cysts are seen

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6.
Fig. 6. OCT-image in High Resolution Corneal mode, therapeutic contact lens on the cornea, valve-like flap covering the area of perforation is visualized in cornea

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7.
Fig. 7. Outcomes of acute corneal hydrops: а – symptom “fish mouth” sign (arrows); b – local corneal scar; c – extensive corneal scarring involving the optic area

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