Management of acute corneal hydrops in keratoconus with pre‐Descemet's membrane sutures

Purpose To report three cases of corneal hydrops in patients with keratoconus that were managed with pre‐descemet's membrane (DM) sutures associated with intracameral air injection assisted with the ZEISS RESCAN 700 surgical microscope under general anesthesia to shorten the period of corneal edema, to achieve corneal stability and to reduce the duration of the use of carbonic anhydrase inhibitor. Methods The first patient, a 27‐year‐old man affected by a Down's syndrome associated with a bilateral keratoconus presented with corneal hydrops in his right eye resulting from a central vertical tear in DM. Three horizontal pre‐DM sutures were performed. The second patient, a 26‐year‐old man affected by a Down's syndrome associated with a bilateral keratoconus presented with corneal hydrops in his left eye resulting from a central horizontal tear in DM. Five vertical pre‐DM sutures were achieved. The third patient, a 43‐year‐old woman with bilateral keratoconus presented with corneal hydrops in her left eye resulting from a central vertical tear in DM. Four horizontal pre‐DM sutures were achieved. Results One month after the pre‐DM sutures, the edema resolved clinically and the pachymetry dramatically decreased on anterior segment OCT. The visual acuity of the Two first patients, while subjectively improved, were not measurable, the third patient visual acuity improved from counting fingers at 1 foot to 1,4logMAR at 20 foots from day one to month six. Conclusions Intrastromal pre‐DM sutures and intracameral air injection could promptly restore imperviousness of posterior stroma. This technique seems to be a useful procedure to shorten acute corneal hydrops. This impressive clinical response to stromal sutures led us to hypothesize that the pathogenesis of corneal hydrops may correspond to an acute ‘fracture’ of the corneal stroma secondarily leading to DM tear.