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Surgical approaches show differing visual outcomes in acute corneal hydrops

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Key Takeaways

  1. CSAI resolved corneal edema in about two weeks but resulted in the least visual improvement at final follow-up.
  2. CSAI followed by DALK produced better visual acuity than CSAI alone, with no long-term complications reported in this group.
  3. PKP achieved the best postoperative visual acuity but was associated with a case of graft rejection.

Compression sutures with intracameral air injection (CSAI), CSAI followed by deep anterior lamellar keratoplasty (DALK), and penetrating keratoplasty (PKP) all improved vision in acute corneal hydrops, but showed different tradeoffs, according to a study.

The study included 26 patients (26 eyes) who underwent CSAI-only (7 eyes), CSAI plus DALK (14 eyes), and PKP (5 eyes). Researchers collected demographic data and measured best-corrected visual acuity (BCVA), corneal edema area, central corneal thickness, and corneal curvature during the acute phase. After treatment, they assessed resolution time following CSAI, final BCVA, corneal curvature, thickness, astigmatism, and complications.

Mean resolution of corneal edema after CSAI was about 2 weeks. Visual acuity improved significantly in all groups (P < 0.05). At final follow-up, mean postoperative BCVA (logMAR) was 0.60 ± 0.15 in the CSAI-only group, 0.34 ± 0.16 in the CSAI+DALK group, and 0.15 ± 0.09 in the PKP group.

Among the 17 eyes originally scheduled for DALK, Descemet’s membrane perforation occurred in 5 cases. One patient in the PKP group experienced graft rejection. No long-term complications were reported in the CSAI-only or CSAI+DALK groups.

The authors reported that CSAI reduced the duration of ACH but resulted in limited visual improvement. Visual outcomes were greater when DALK was performed after CSAI resolution, while PKP achieved the best visual acuity but was associated with graft rejection in one case.

Reference
Bai J, Li S, Liu C, et al. Therapeutic Outcomes of Three Surgical Approaches for Acute Corneal Hydrops. J Invest Surg. 2026;39(1):2624147. doi: 10.1080/08941939.2026.2624147. Epub 2026 Feb 10. PMID: 41664636.

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