Retrospective case series on iOCT-guided pneumodescemetopexy for acute corneal hydrops in keratoconus.

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medRxiv Published April 17, 2026 Medically reviewed April 25, 2026 Study authors: Giachos, I.; Oreaba, A. H.; Kanj, U.; Anwar, S.; Chahal, R.; Aralikatti, A.; Ting, D. S. J. DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider that iOCT-guided pneumodescemetopexy may achieve PDL/DM attachment in acute corneal hydrops, based on a small case series.

This source is a retrospective, consecutive, interventional case series from the Birmingham and Midland Eye Centre, UK. The scope was to evaluate iOCT-guided pneumodescemetopexy (18% sulfur hexafluoride gas) combined with corneal compression sutures in 5 patients with keratoconus who presented with significant acute corneal hydrops. The primary outcome was complete PDL/DM attachment, and secondary outcomes included corrected-distance-visual-acuity (CDVA) and time from surgery to ACH resolution.

The authors report that complete PDL/DM attachment was achieved in all 5 cases. CDVA showed a significant improvement from the preoperative state to the last follow-up, with a mean improvement of 0.52 +/- 0.32 logMAR (p=0.014). The mean time from surgery to ACH resolution was 17.8 +/- 8.0 days. The mean follow-up duration was 16.3 +/- 5.6 months.

Key limitations noted by the authors include that one patient required a repeat procedure to fully attach the PDL/DM. Adverse events, serious adverse events, discontinuations, and tolerability were not reported. The study is a small, single-center case series, which limits generalizability.

Practice relevance was not reported. The findings suggest that this intervention may be associated with anatomical attachment and visual improvement in this specific context, but the evidence is preliminary and from a non-comparative design.

Study Details

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

Purpose: To highlight the roles of intraoperative optical coherence tomography (iOCT) in managing acute corneal hydrops (ACH) and outcomes of iOCT-guided pneumodescemetopexy and corneal compression sutures. Methods: This was a retrospective, consecutive, interventional case series of patients with keratoconus who presented with significant ACH and underwent iOCT-guided pneumodescemetopexy (18% sulfur hexafluoride gas) and compression sutures at Birmingham and Midland Eye Centre, UK, between Aug 2023 and May 2025. Results: Five patients were included; mean age was 32.3+/-6.6 years old and 3 (60%) were male. The mean follow-up duration was 16.3+/-5.6 months. At presentation, the mean corrected-distance-visual-acuity (CDVA) was 1.90+/-0.67 logMAR, central corneal thickness (CCT) was 1187.6+/-372.6um, maximal corneal thickness was 1624.0+/-383.5um and maximal height and diameter of pre-Descemet layer/Descemet membrane (PDL/DM) detachment was 1014.6+/-366.4um and 4456.0+/-839.4um, respectively. The surgery successfully achieved complete PDL/DM attachment in all cases, with a mean time from surgery to ACH resolution of 17.8+/-8.0 days. iOCT successfully visualized the area of PDL/DM break/detachment, revealed the involvement of PDL (evidenced by a persistent taut type 1 DM detachment after gas tamponade), and guided the placement of compression sutures. Compared to preoperative, there was a significant improvement in the mean CDVA (0.52+/-0.32 logMAR; p=0.014) at last follow-up. One patient required a repeat procedure to fully attach the PDL/DM. Conclusions: This study demonstrated favorable outcomes of iOCT-guided pneumodescemetopexy and corneal compression sutures. iOCT revealed the involvement of PDL in ACH and provided plausible explanations why pneumodescemetopexy alone may not be able to resolve significant ACH rapidly in certain cases.