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 Table of Contents    
CLINICAL IMAGE
Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 65-66  

Pneumodesmetopexy with perfluoropropane for acute corneal hydrops in keratoconus


Department of Cornea and Anterior Segment, Anand Eye Institute, Hyderabad, Telangana, India

Date of Web Publication30-Jan-2019

Correspondence Address:
Dr. Arjun Srirampur
Anand Eye Institute, Habsiguda, Hyderabad - 500 007, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_30_2018

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   Abstract 


Acute corneal hydrops (CH) occurs when there is a tear in descemets membrane causing rolling of its edges, creating a gap through which aqueous from anterior chamber (AC) percolates into corneal stroma. Acute CH occurs in approximately 2.5-3% of eyes with KC. Conventional therapy is patching or bandage contact lens application with topical cycloplegics and topical hypertonic sodium chloride. Here, we report a case of 9-year-old boy with bilateral keratoconus with left eye acute hydrops who was successfully treated with pneumodesmetopexy with perflouropropane (C3F8).

Keywords: Acute corneal hydrops, perfluoropropane, pneumodesmetopexy


How to cite this article:
Srirampur A, Kalwad A. Pneumodesmetopexy with perfluoropropane for acute corneal hydrops in keratoconus. Oman J Ophthalmol 2019;12:65-6

How to cite this URL:
Srirampur A, Kalwad A. Pneumodesmetopexy with perfluoropropane for acute corneal hydrops in keratoconus. Oman J Ophthalmol [serial online] 2019 [cited 2019 May 20];12:65-6. Available from: http://www.ojoonline.org/text.asp?2019/12/1/65/251038




   Introduction Top


Acute corneal hydrops (CH) occurs when there is a tear in Descemet's membrane (DM) causing rolling of its edges, creating a gap through which aqueous from anterior chamber (AC) percolates into corneal stroma. Ectatic conditions of the cornea such as keratoconus (KC), keratoglobus, and pellucid marginal corneal degeneration are associated with occurrence of CH. The first case of CH in KC was reported by Plaut as a sudden occurring opacity at the apex of cornea due to a rupture of DM which was later confirmed by Axenfeld. Acute CH occurs in approximately 2.5%–3% of eyes with KC. Most cases are seen in the second or third decade. There is preponderance for male gender, and bilaterality is rare.[1] Predisposing factors include poor visual acuity at presentation, early age of onset of ectasia, and vigorous eye rubbing.

Conventional therapy is patching or bandage contact lens application with topical cycloplegics and topical hypertonic sodium chloride. However, during recovery, patient suffers from severe photophobia and irritation. Spontaneous resolution usually occurs by endothelial sliding, over a period of 2–4 months. In some cases, the presence of stromal clefts delays resolution and persistent edema can incite inflammation and vascularization that may adversely affect chances of graft survival later. Intracameral injection of air or nonexpansile gas mixtures (14% perfluoropropane [C3F8], 20% SF6) shortens recovery period by blocking entry of aqueous into stroma.[2]


   Case Report Top


A 9 year old boy presented to our hospital with complaints of sudden decrease of vision in the left eye (LE) for the past 10 days following a vigorous eye rubbing episode. On examination, his visual acuity in the right eye (RE) was 6/36 improving to 6/9 (with pinhole) and that in the LE was hand movements. Slit-lamp examination of the RE revealed superficial corneal scar with central corneal ectasia with Vogt's striae. Rest anterior segment was unremarkable. LE showed [Figure 1] central corneal ectasia with dense stromal edema, and rest of the anterior segment could not be visualized. Dilated fundus examination of the RE was within normal limits, and B-scan of the RE showed a normal posterior segment. Based on the above clinical findings, a diagnosis of bilateral KC with LE acute hydrops was made. He underwent pneumodesmetopexy with C3F8 in the LE.
Figure 1: Photograph of the anterior segment of the left eye showing diffuse corneal edema with advanced keratoconus. Other anterior segment details are not visible

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AC paracentesis under aseptic conditions with a 26-gauge needle was made. First, air was injected to completely fill AC and after 10 min was replaced with 14% of C3F8 enough to fill two-thirds of AC. Postoperatively, patient supine position was advised along with topical antibiotics and steroids. Intraocular pressure (IOP) was normal postoperatively. At follow-up of 12 months, corneal edema completely resolved and the patient had best-corrected visual acuity of 6/9 (with contact lens) and nebular grade corneal scar with normal IOP [Figure 2].
Figure 2: Slit-lamp photograph of anterior segment of left eye showing corneal nebular grade scar at the center with rest of the cornea and otherwise normal anterior segment at 12 months follow-up

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   Discussion Top


The choice of C3F8 for pneumodesmetopexy was made as it is longest acting among all and usually repeat injections are not required. Air stays for short time and SF6 though is long acting compared to air, repeat injections may still be required.[3],[4] These agents prevent aqueous penetration into stroma and unroll torn ends of ruptured DM. This procedure does not affect final visual outcome but reduces morbidity and risk of complication.

Possible intraoperative complications are IOP rise due to pupillary block, inadvertent intrastromal gas injection, and injury to the lens.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Maharana PK, Sharma N, Vajpayee RB. Acute corneal hydrops in keratoconus. Indian J Ophthalmol 2013;61:461-4.  Back to cited text no. 1
  [Full text]  
2.
Rajaraman R, Singh S, Raghavan A, Karkhanis A. Efficacy and safety of intracameral perfluoropropane (C3F8) tamponade and compression sutures for the management of acute corneal hydrops. Cornea 2009;28:317-20.  Back to cited text no. 2
    
3.
Miyata K, Tsuji H, Tanabe T, Mimura Y, Amano S, Oshika T, et al. Intracameral air injection for acute hydrops in keratoconus. Am J Ophthalmol 2002;133:750-2.  Back to cited text no. 3
    
4.
Panda A, Aggarwal A, Madhavi P, Wagh VB, Dada T, Kumar A, et al. Management of acute corneal hydrops secondary to keratoconus with intracameral injection of sulfur hexafluoride (SF6). Cornea 2007;26:1067-9.  Back to cited text no. 4
    
5.
Garg J, Mathur U, Acharya MC, Chauhan L. Outcomes of descemetopexy with isoexpansile perfluoropropane after cataract surgery. J Ophthalmic Vis Res 2016;11:168-73.  Back to cited text no. 5
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