Intrastromal fluid drainage with air tamponade: anterior segment optical coherence tomography guided technique for the management of acute corneal hydrops.

Abstract

To describe a new technique of corneal stab incision with intracameral air injection for management of patients with acute corneal hydrops. Five patients with acute corneal hydrops with large Descemet's membrane (DM) detachment and multiple stromal clefts underwent the procedure. The technique entailed anterior segment optical coherence tomography guided intrastromal fluid drainage through multiple corneal stromal venting incisions along with anterior chamber air tamponade. The time taken for the DM to reattach, resolution of corneal oedema and the best-corrected visual acuity (BCVA) were assessed postoperatively. Five patients (age range, 10-25 years) with large DM detachment underwent the procedure. The presenting visual acuity varied from hand motions close to face to 1/60. No intraoperative complications were encountered. The DM attached on first postoperative day in four out of five cases. The corneal oedema resolved over 2-3 weeks in all cases. Repeat air injection was not required in any of the cases. All patients had a final BCVA of ≥3/60 with two of them achieving a BCVA of ≥6/24 at three months postoperatively. The technique of intrastromal drainage of fluid combined with air tamponade can be effectively used as a treatment modality for the management of severe cases of acute corneal hydrops.