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Retrospective case series on iOCT-guided pneumodescemetopexy for acute corneal hydrops in keratoconusCan a quick eye surgery fix painful corneal swelling in keratoconus patients?

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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.

Imagine waking up with a cornea that is swollen, painful, and blurring your vision. This condition, called acute corneal hydrops, can happen to people with keratoconus, a disease that thins the eye's clear front window. In a recent look back at five patients treated at the Birmingham and Midland Eye Centre in the UK, doctors used a technique involving a tiny amount of gas and compression stitches to fix the problem. The goal was to reattach the corneal layers so the swelling would go away and sight would return.

The results were encouraging for this small group. Every single patient had their corneal layers successfully reattached. Their vision improved significantly by the end of the study, and the painful swelling resolved within an average of about 18 days. No serious safety issues or side effects were reported during this short follow-up period.

But there is a catch. This study only looked at five people, and one of them needed a second procedure to fully heal. While the technique worked well for this specific group, the small number of patients means we cannot yet say this is a guaranteed fix for everyone. More research is needed to see if these results hold true for larger groups of patients.

What this means for you:
A specific surgery helped all five patients heal from painful corneal swelling, but the small group size means results are not yet certain.

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.
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