Different compression sutures combined with intracameral air injection for acute corneal hydrops

·AIM:To evaluate the efficacy and safety of full-thickness sutures combined with intracameral air injection(FTS-AI)versus pre-Descemet’s membrane sutures combined with intracameral air injection(PDS-AI)in the management of acute corneal hydrops in keratoconus.·METHODS:The research included 8 patients(8 eyes)suffering from acute corneal hydrops caused by keratoconus.Four patients were randomly assigned to FTS-AI.And the other four were randomly assigned to PDS-AI.Corneal oedema,visual acuity,corneal thickness were assessed during follow-up.·RESULTS:The demographics,preoperative duration of symptoms and severity of corneal hydrops between the two groups were not significantly different.The mean corneal oedema resolution time after FTS-AI and PDSAI were 11±1.15 and 15±1.41 d,respectively(P=0.005).The maximum corneal thickness of the scarred region decreased in both groups at one week postoperatively(P<0.05).No obvious difference was found in the mean maximal corneal thickness between the two groups postoperatively.The BCVA improved significantly after FTS-AI and PDS-AI at three months postoperatively.No obvious difference was found in the BCVA after FTS-AI and PDS-AI at three months postoperatively.·CONCLUSION:FTS-AI and PDS-AI are safe and effective therapies to accelerate the resolution of corneal oedema in acute corneal hydrops secondary to keratoconus.Despite faster resolution of corneal oedema in the FTS-AI group,we recommend PDS-AI to avoid potential endothelium cell damage.

One-step thermokeratoplasty for pain alleviating and pre-treatment of severe acute corneal hydrops in keratoconus

AIM:To observe the efficacy of simplified one-step thermokeratoplasty for the treatment of severe acute corneal hydrops in keratoconus.METHODS:In this retrospective,noncomparative clinical study,10 patients(10 eyes) with acute hydrops in keratoconus were treated with simplified one-step thermokeratoplasty.Pain,changes in the corneal curvature,thickness,and size and morphology of the Descemet membrane breaks were detected before and after surgery.Eight patients were successfully treated using modified deep anterior lamellar keratoplasty(DALK).Graft transparency,visual acuity,and immunological rejection were evaluated for 6 to 12mo.RESULTS:Pain and corneal oedema were promptly alleviated,and the intrastromal ruptures diminished within 3 to 6wk after thermokeratoplasty.At 3 to 6wk after corneal oedema was faded,Descemet membrane breaks and intrastromal ruptures were healed.Two patients did not undergo subsequent corneal transplantation after thermokeratoplasty.Eight patients underwent DALK successfully and safely after thermokeratoplasty,without corneal perforation.Central corneal opacity faded or disappeared within 6mo.The mean best-corrected visual acuity was increased to 20/30 at 12mo after DALK.No one was observed with any immune rejection.CONCLUSION:One-step thermokeratoplasty can successfully and efficiently accelerate the absorption of prominent corneal oedema in severe acute hydrops patients.This simple procedure with no complications can be performed in the emergency department by residents.This method can improve the safety of DALK and obtain good postoperative vision.Long-term management of acute corneal hydrops using simplified one-step thermokeratoplasty seems promising.