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Bafna RK, Kalra N, Asif MI, Beniwal A, Lata S, Sharma SV, Agarwal R, Vanathi M, Maharana PK, Titiyal JS, Sharma N. Management of acute corneal hydrops - Current perspectives. Indian J Ophthalmol 2024; 72:495-507. [PMID: 38317314 PMCID: PMC11149508 DOI: 10.4103/ijo.ijo_2160_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/16/2023] [Indexed: 02/07/2024] Open
Abstract
Acute corneal hydrops (ACH) is a rare but sight-threatening complication of corneal ectasias. We aim to review the current literature on etiopathogenesis, histology, role of ancillary investigations, management, and outcomes of ACH by classifying the various management strategies based on their site of action and the underlying mechanism. A review of the literature was conducted by searching the following databases: PubMed (United States National Library of Medicine), Embase (Reed Elsevier Properties SA), Web of Science (Thomson Reuters), and Scopus (Elsevier BV) till April 2023. The literature search used various combinations of the following keywords: acute corneal hydrops, keratoconus, ectasia, management, keratoplasty. Nine hundred eighty-three articles were identified based on the above searches. Case reports which did not add any new modality of treatment to the existing literature, articles unrelated to management, those with no full text available, and foreign-language articles with no translation available were excluded. Eventually, 75 relevant articles that pertained to the management of ACH were shortlisted and reviewed. Recent studies have described newer surgical interventions like full-thickness or pre-Descemetic sutures, thermokeratoplasty, and plasma injection that aim to close the posterior stromal break. Posterior lamellar keratoplasties act by replacing the posterior torn Descemet's membrane (DM), and early deep anterior lamellar keratoplasty (DALK) has been attempted to combine the correction of the anatomical defect and visual rehabilitation in a single surgery. These surgical interventions may help by reducing the scarring and increasing the number of patients who can be visually rehabilitated with contact lenses rather than keratoplasty.
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Affiliation(s)
- Rahul K Bafna
- Department of Ophthalmology, Vasan Eye Care Center, Vizag, Andhra Pradesh, India
| | - Nidhi Kalra
- Department of Ophthalmology, 151 Base Hospital, Guwahati, Assam, India
| | - Mohamed I Asif
- Department of Ophthalmology, Eye 7 Eye Hospital, Lajpat Nagar, Delhi, India
| | - Abhijeet Beniwal
- Department of Ophthalmology, RP Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Suman Lata
- Department of Ophthalmology, Grewal Eye Hospital, Chandigarh, India
| | - Sumant V Sharma
- Department of Ophthalmology, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rinky Agarwal
- Department of Ophthalmology, Lady Hardinge Medical College, Delhi, India
| | - Murugesan Vanathi
- Department of Ophthalmology, RP Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, RP Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Jeewan S Titiyal
- Department of Ophthalmology, RP Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, RP Centre of Ophthalmic Sciences, AIIMS, New Delhi, India
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Bachmann BO, Matthaei M, Schlereth S, Cursiefen C. Corneal Hydrops - Aetiology and Advanced Therapeutic Strategies. Klin Monbl Augenheilkd 2023. [PMID: 37146638 DOI: 10.1055/a-2048-6703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Acute hydrops refers to sudden corneal edema caused by rupture of Descemet's membrane (DM) - often in progressive keratectasia. It leads to a sudden decrease in visual acuity, pain, and foreign body sensation as well as an increased glare sensation. Acute hydrops usually heals with scarring within months, but complications such as corneal perforation, infectious keratitis, and corneal vascularization may occur. The prevalence in keratoconus patients is 2.6 to 2.8%. Risk factors include keratoconjunctivitis vernalis, atopic dermatitis, high keratometry, male gender, and eye rubbing. Keratoplasty should be avoided in the acute phase. The prognosis of the graft is reduced, and after scar healing of the hydrops, wearing contact lenses or glasses may be possible again. Conservative therapy alone with lubricants and hyperosmolar eye drops, prophylactic antibiotic eye drops to prevent superinfection, and topical steroids was long considered the only possible form of treatment. However, healing under conservative therapy takes an average of over 100 days. In the meantime, there are different surgical strategies that rapidly shorten the healing and thus the recovery phase of the patients to a few days. If the DM is detached without tension, a simple injection of gas into the anterior chamber can already lead to reattachment and thus to almost immediate deswelling of the cornea. If the DM is under tension, predescemetal sutures combined with a gas injection into the anterior chamber can flatten the cornea and reattach the DM. Mini-Descemet membrane endothelial keratoplasty (mini-DMEK) allows for sutureless closure of the DM defect by transplantation of a small (< 5 mm) graft. In cases of particularly large DM tears and very pronounced hydrops, suture loosening and relapse may occur after the placement of predescemetal sutures. Mini-DMEK can then lead to permanent healing, but in contrast to simple corneal sutures, it is usually performed under general anesthesia and by aid of intraoperative optical coherence tomography. The very good results with regard to the rapid healing prove that surgical therapy makes sense in the vast majority of patients with acute hydrops and should be initiated quickly.
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Affiliation(s)
- Björn O Bachmann
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
| | - Mario Matthaei
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
| | - Simona Schlereth
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
| | - Claus Cursiefen
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
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Influence of Body Position on Intraocular Pressure After Descemet Membrane Endothelial Keratoplasty: A Prospective Randomized Trial. Cornea 2023; 42:320-325. [PMID: 35249977 DOI: 10.1097/ico.0000000000003010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to analyze the influence of patient positioning on intraocular pressure (IOP) after Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic patients treated for Fuchs endothelial corneal dystrophy. METHODS Forty patients were included in this prospective, single-blinded, randomized controlled clinical trial. Patients received a YAG iridotomy 1 day before surgery and an 80% anterior chamber tamponade [20% concentration of sulfur hexafluoride (SF6)]. Postoperative positioning was either supine (group 1) or seated (group 2, at least 30 degrees upper-body high position). IOP was measured with iCare. RESULTS There was no statistically significant difference in IOP postoperatively [group 1 vs. group 2-after 1h: 13.9 mm Hg (±4.2 mm Hg) versus 13.6 mm Hg (±4.1 mm Hg) ( P = 1.00); after 2h: 13.9 mm Hg (±5.4 mm Hg) versus 15.3 mm Hg (±4.6 mm Hg) ( P = 0.370); after 4h: 13.8 mm Hg (±4.2 mm Hg) versus 15.2 mm Hg (±4.2 mm Hg) ( P = 0.401]. In group 1, 10% of patients showed IOP decompensations well above 30 mm Hg, and in group 2, there were no IOP decompensations. Seated position led to relative risk reduction of 100% and absolute risk reduction of 10% regarding IOP decompensations. The number of patients needed to position seated to prevent 1 additional IOP decompensation was 10. Rebubbling rates, best spectacle-corrected visual acuity, and reduction of corneal thickness were comparable between the 2 groups in the follow-up period up to 1 month. CONCLUSIONS After DMEK in pseudophakic eyes with 80% anterior chamber tamponade, positioning patients with at least 30 degrees elevation of the upper body up immediately after surgery until bedtime prevents IOP decompensations.
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Tahmaz V, Schöneberger V, Cursiefen C. [Posterior lamellar keratoplasty (DMEK) for chronic focal corneal endothelial-epithelial decompensation 7 years after ocular contusion (contusio bulbi)]. DIE OPHTHALMOLOGIE 2023; 120:209-212. [PMID: 35441263 DOI: 10.1007/s00347-022-01633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- V Tahmaz
- Univ.-Augenklinik Köln, Gebäude 34, Kerpener Str. 62, 50931, Köln, Deutschland.
| | - V Schöneberger
- Univ.-Augenklinik Köln, Gebäude 34, Kerpener Str. 62, 50931, Köln, Deutschland
| | - C Cursiefen
- Univ.-Augenklinik Köln, Gebäude 34, Kerpener Str. 62, 50931, Köln, Deutschland
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Händel A, Siebelmann S, Matthaei M, Cursiefen C, Bachmann B. Mini-DMEK for the Treatment of Chronic Focal Corneal Endothelial Decompensation. Cornea 2022; 42:12-19. [DOI: 10.1097/ico.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
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Händel A, Lüke JN, Siebelmann S, Franklin J, Roters S, Matthaei M, Bachmann BO, Cursiefen C, Hos D. Outcomes of deep anterior lamellar keratoplasty and penetrating keratoplasty in keratoconic eyes with and without previous hydrops. Graefes Arch Clin Exp Ophthalmol 2022; 260:2913-2923. [PMID: 35389058 DOI: 10.1007/s00417-022-05643-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The study aims to compare outcomes after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in keratoconic eyes with or without previous hydrops. METHODS Retrospective analysis of 211 eyes who received PK (group 1, n = 74 [history of hydrops: n = 33]) or DALK (group 2, n = 137 [history of hydrops: n = 9]) from 2012 to 2019 at the Department of Ophthalmology, University of Cologne, Germany. Analysis included best spectacle-corrected visual acuity (BSCVA), complications, immune reactions, graft survival and keratometry, and subgroup analyses for subjects with or without previous hydrops. RESULTS Follow-up was 34.0 ± 23.6 months in group 1 and 30.7 ± 22.5 months in group 2. No significant difference was found in the course of BSCVA between groups 1 and 2 (p = 0.182) and in postoperative BSCVA between eyes with and without previous hydrops, regardless of the surgical method (p = 0.768). Endothelial immune reactions occurred exclusively in group 1 and did not occur more frequently in eyes with previous hydrops (p = 0.377). A higher risk of complications for eyes with previous hydrops was observed (p = 0.022). There was no difference in astigmatism and maximum keratometry (Kmax) preoperatively and postoperatively between eyes with and without history of hydrops. CONCLUSION The prognosis for visual outcome after keratoplasty including visual acuity, astigmatism, and Kmax for keratoconic eyes with previous hydrops is as good as for keratoconic eyes without previous hydrops, irrespective of the surgical method. However, eyes after hydrops seem to have an increased risk of complications.
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Affiliation(s)
- Alexander Händel
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Jan Niklas Lüke
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Sebastian Siebelmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics and Bioinformatics, Cologne, Germany
| | - Sigrid Roters
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Björn O Bachmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50937, Cologne, Germany
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50937, Cologne, Germany
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Use of a Single Radial Incision to Improve Curvature Matching and Graft Adhesion in Descemet Membrane Endothelial Keratoplasty in a Patient With Keratoconus. Cornea 2022; 41:921-926. [DOI: 10.1097/ico.0000000000002991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
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