Vol. 7, Issue 1, Part A (2025)

Background: Corneal hydrops is a rare but severe complication of ectatic corneal disorders, most commonly keratoconus. It results from a rupture in Descemet’s membrane, leading to stromal edema and acute vision loss. Recent advances have improved diagnostic accuracy and therapeutic options.

Case Presentation: We report the case of a 32-year-old female with bilateral keratoconus, previously managed with scleral lenses, who presented with acute pain and vision loss in her right eye. Clinical examination revealed corneal edema, a deep anterior chamber, and a rupture in Descemet’s membrane confirmed by anterior segment OCT. Initial visual acuity was limited to counting fingers.

Management and Outcome: The patient was treated with cycloplegics, oral acetazolamide, and ocular hypotensives. Surgical intervention included pre-Descemetic sutures and intracameral injection of 20% sulfur hexafluoride (SF6). Within 48 hours, significant clinical improvement was noted with a reduction in corneal thickness from 1148 μm to 493 μm and a clear central cornea. A peripheral stromal opacity remained but did not affect central vision.

Discussion: This case illustrates the effectiveness of early surgical intervention using intraocular gas in managing acute corneal hydrops. Combined with medical therapy, this approach facilitates rapid recovery, reduces corneal edema, and minimizes long-term visual impairment. Visual prognosis is closely linked to the location of residual scarring relative to the visual axis.

Conclusion: Intraocular gas injection, originally used in posterior segment surgery, has emerged as a highly effective treatment for acute corneal hydrops in keratoconus. Prompt diagnosis and combined medical-surgical management are essential to achieving favorable outcomes.