Compression sutures plus air tamponade improve outcomes for corneal hydrops

This prospective, multicenter randomized clinical trial compared the efficacy of compression sutures plus intracameral air injection (CSAI) and thermokeratoplasty (TKP) for the management of acute corneal hydrops in patients with keratoconus.

Study design

Twenty Chinese patients with keratoconus and acute corneal hydrops were enrolled in the study; the follow-up interval was 6 months. Hydrops severity was graded based on the widest diameter of corneal edema measured by anterior segment OCT.

Outcomes

Hydrops severity and duration of symptoms prior to treatment were comparable between the groups. The rate of hydrops resolution was not explicitly studied, with all patients achieving clinical resolution of corneal edema at a predefined 2-week follow-up. However, the CSAI group achieved superior 6-month outcomes compared with the TKP group for all studied parameters, including BCVA, mean keratometry values (52.1 D vs. 63.5 D, respectively) and maximum keratometry values (65.2 D vs. 77.1 D).

Limitations

Comparisons of postsurgical keratometry values between the study groups are limited because pre-hydrops keratometry values were not reported (i.e., the change in keratometry values from patients’ pre-hydrops baseline was not studied). Results of this study are also limited by a modest sample size and the relatively short 6-month follow-up period.

Clinical significance

Both CSAI and TKP can achieve resolution of corneal edema by 2 weeks, but the combination of stromal compression sutures and air tamponade might enable surgeons and patients to defer keratoplasty, as it may yield superior BCVA by way of flatter corneal curvature.