-A split in the DM, Dua’s layer, and endothelium allows the aqueous to enter the cornea, leading to edema in acute corneal hydrops
-Conservative management may take 2-4 months for spontaneous resolution of edema
-Large tears may take even longer or need keratoplasty
-Longer duration of edema increases the chances of vascularization, which in turn increases the possibility of graft rejection in subsequent keratoplasty
-Compression sutures, both partial and full-thickness, with descemetopexy can be done
Preoperative planning
-The site of DM tear is identified on slit lamp examination and AS OCT
Surgery
10-0 nylon sutures are passed through the stroma, perpendicular to the tear in the DM
-The sutures are taken across the area of corneal edema, at the junction of the edematous and clear cornea
-The lateral extents are sutured first followed by central sutures
-The length and number of the sutures depend on the extent of edema and the size of the tear
-Intraoperative resolution of corneal edema can happen and in those cases, the loose sutures need to be retaken
-The sutures are buried away from the visual axis and BCL is placed after ensuring water tightness
POST-OPERATIVELY:
-Tapering dose of steroids and antibiotics
-Loose sutures removed as and when required
-Remaining sutures at 3 months post op
-CL trial can be done after suture removal to determine BCVA
Image from Rajan Eye Care Hospital
Comentários