Sir,

Acute corneal hydrops is the rapid development of corneal edema due to tears in the Descemet’s membrane. Perfluropropane gas (C3F8) injection has been found useful in early resolution of hydrops.1 Although gas injection has been found to accelerate the recovery of corneal hydrops, hydrops resolves spontaneously in most cases and reports of accelerated recovery do not refer to any control group. We present a case of hydrops in severe keratoconus managed by C3F8 injection and visually rehabilitated by deep anterior lamellar keratoplasty (DALK).

Case report

A 19-year-old male presented in December 2012 with corneal hydrops of 3 weeks duration in his left eye. The Descemet’s tear was central and localized. Non-expansile 14% C3F8 gas was injected in the operating room. Three weeks following injection, edema totally resolved (Figure 1). OCT showed extensive thinning of the entire cornea (Figure 2).

Figure 1
figure 1

Diffuse slit-lamp view showing resolved hydrops following C3F8 injection.

Full size image
Figure 2
figure 2

OCT image after resolution of hydrops.

Full size image

On 31 March 2013, DALK was performed. Partial thickness trephination was done with 9 mm trephine, which was decentered inferiorly to include the cone. Lamellar dissection was done manually without injection of air into the corneal stroma. Donor graft (9.5 mm) was sutured to the bed after removing the DM.

Following surgery, the patient had a visual acuity of 20/80 with a correction of −4.5 D/−1.5 D Cyl @70 degrees. Descemet’s scar was visible (Figure 3).

Figure 3
figure 3

Diffuse slit-lamp view of the same eye following DALK with Descemet’s membrane scar.

Full size image

Comment

Intracameral C3F8 gas is a useful modality for fast resolution of corneal edema in acute corneal hydrops in keratoconus.2 Although clinically early resolution of edema has been noted in case reports and series, complications of glaucoma and fixed dilated pupil in acute corneal hydrops or following DALK have been reported.3, 4, 5 A case report of non-resolution of acute hydrops because of intrastromal migration of C3F8 gas has been reported.6 Hence, careful follow-up of intraocular pressure and gas status is mandatory after C3F8 gas injection.

We decided to do DALK in the case reported, as the thinning was extensive and was reaching the limbus. Zhang et al7 reported satisfactory visual outcomes with both PK and DALK in treating keratoconus.

To conclude, we present a case of hydrops managed by C3F8 injection followed by DALK.