Abstract
Acute hydrops refers to sudden corneal edema caused by rupture of Descemetʼs 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.
Key words
acute hydrops - corneal edema - predescemetal sutures - mini-DMEK
