A modified technique of compression sutures combined with intracameral sulfur hexafluoride (SF6) for acute corneal hydrops

This study aimed to present cases of acute corneal hydrops managed using a modified compression suture technique and intracameral air/gas tamponade. Eight cases presented to the emergency room with acute drop in vision, corneal opacity, and Descemet’s membrane defects. The primary diagnoses included keratoconus in six cases, pellucid marginal degeneration (PMD) in one, and post-refractive ectasia in one. They were managed using a modified compression suture technique and intracameral air/gas tamponade. The procedure included creating a small surgical inferior peripheral iridectomy, followed by intracameral injection of sulfur hexafluoride (SF6) 20% or air, and suturing the Descemet’s membrane defect with 10-0 Prolene using a straight needle in a continuous crisscross, horizontal cruciate mattress full-thickness technique. A total of eight eyes from eight patients were included. The series consisted of four males (50%) and four females (50%), with a median age of 27 years (range: 12–58 years). The median duration of hydrops symptoms prior to presentation was 24 days (range: 16–60 days). Uncorrected visual acuity at presentation ranged from 20/200 to hand motion. The median time for corneal edema resolution postoperatively was 2 weeks (range: 1–3 weeks). Sutures were removed at two months with no documented recurrences. Final uncorrected visual acuity ranged from 20/50 to 20/200, with a median of 20/80, excluding one patient with a difficult-to-assess visual acuity. The modified compression suturing technique appears to be an effective alternative with a double mattress effect for expediting corneal edema resolution and Descemet’s membrane defect closure. Advantages include facilitating contact lens fitting and reducing the risk of corneal neovascularization. This technique may be particularly beneficial for pediatric and high-risk patients, including those who are mentally challenged, when postponing keratoplasty is necessary.