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

Microscope-Integrated Optical Coherence Tomography-Guided Rapid Resolution of Acute Hydrops

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.

Strategies and Application of Compression Sutures With a Modified Technique for Rapid Resolution of Large (Grade III) Hydrops: A Prospective Interventional Study

PURPOSE

The aim of this study was to describe the strategies and outcomes, with a modified technique, of compression sutures in large acute hydrops.

METHODS

This was a prospective interventional study in 29 eyes of 28 patients who underwent compression sutures using a modified technique. The degree of resolution after surgical intervention was quantified by 3 masked observers, using the slit-lamp photographic documentation and optical coherence tomography. The degree of resolution, best-corrected visual acuity, and complications were analyzed.

RESULTS

The mean age was 20.89 (7-46) years. Five patients had pellucid marginal degeneration (pellucid marginal corneal degeneration), 23 had keratoconus, and 1 had posttrauma hydrops. The preoperative visual acuity was hand motions in all eyes. The reduction in edema was 76% on day 1, 91.6% on 6 ± 2 days, 98.6% on 18 ± 3 days from surgical intervention. The baseline pachymetry assessed on optical coherence tomography was beyond measurement in 26 eyes. The mean pachymetry at day 1 was 704 μm (range 480-950) which reduced to 607 (range 422-850) microns at 6 ± 2 days and 518 (range 415-718) microns at 18 ± 3 days postintervention ( P < 0.0001). The mean duration between the surgery and complete suture removal was 48 (35-68) days. No suture-related complications were noted. Twenty eyes could attain good visual rehabilitation with glasses/contact lenses (vision could not be assessed in 5 eyes). Penetrating keratoplasty was performed on 1 patient.

CONCLUSIONS

Compression sutures using the modified technique was safe and effective in the rapid resolution of acute hydrops in keratoconus and pellucid marginal corneal degeneration. No complications were noted, and visual restoration with spectacles and contact lenses was satisfactory.

Knockout of TMEM206 in mice associated with a loss of corneal transparency

AIM

To investigate the role of transmembrane protein 206 (TMEM206) in corneal edema in mice by knockout the TMEM206 gene using CRISPR/Cas9 editing technology.

METHODS

TMEM206-knockout mice were generated using the CRISPR-Cas9 system. Variations in ophthalmic pathology were observed using slit lamp microscope and optical coherence tomography (OCT), intraocular pressure (IOP) was measured using a TonoLab Rebound Tonometer, and the ultrastructure of the corneal was observed using a transmission electron microscope.

RESULTS

Corneal opacity was observed in 4/18 homozygous TMEM206-/- mice whereas a similar change was not observed in heterozygous TMEM206+/- mice and wild-type littermates. OCT examination showed that the mean central cornea thickness was 125±5.4 µm in 4 homozygous TMEM206-/- mice developed corneal edema and 115±1.2 µm in wild-type mice (t=3.468, P<0.05) at 43wk. The mean IOP was 12.08±0.07 mm Hg in four right eyes with corneal edema and 12.03±0.03 mm Hg in three normal left eyes (P>0.05). Transmission electron microscopy revealed a disruption in the organization of the collagen fibrils in the central part of the cornea in homozygous TMEM206-/- mice.

CONCLUSION

TMEM206 is associated with corneal edema which caused organizational disruption of collagen fibrils in corneas of mice.

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.