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Microscope-Integrated Optical Coherence Tomography-Guided Drainage of Acute Corneal Hydrops in Keratoconus Combined With Suturing and Gas-Aided Reattachment of Descemet Membrane

Siebelmann, Sebastian MD; Händel, Alexander MD; Matthaei, Mario MD; Bachmann, Björn MD; Cursiefen, Claus MD

doi: 10.1097/ICO.0000000000001958

Purpose: The treatment of acute corneal hydrops due to keratoconus has so far been limited to awaiting the spontaneous resorption of corneal edema, supportive care, and finally keratoplasty. A recent publication describes the surgical reattachment of Descemet Membrane (DM) facilitated by pre-Descemetic sutures and anterior chamber air/gas filling. Here, we present a novel microscope-integrated intraoperative optical coherence tomography (MI-OCT)-guided technique for the immediate reattachment of DM in corneal hydrops due to keratoconus in 2 male patients with small central DM defects.

Methods: Case series of 2 consecutive patients with acute corneal hydrops due to keratoconus. The novel technique consists of the MI-OCT-guided puncture and drainage of intrastromal fluid pockets combined with anterior chamber sulfur hexafluoride-fill and pre-descemetic sutures using a commercially available MI-OCT (iOCT; Haag Streit Surgical, Wedel, Germany).

Results: After uneventful surgery, corneal edema showed fast resolution and DM was reattached to the corneal stroma. In both patient's central corneal thickness decreased after surgery and visual acuity improved.

Conclusions: MI-OCT guided micropuncture of stromal edema combined with compression sutures and SF6 tamponade is a new therapeutic option in acute corneal hydrops with small Descemet membrane defects.

Department of Ophthalmology, University of Cologne, Cologne, Germany.

Correspondence: Sebastian Siebelmann, MD, Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany (e-mail:

Funding: DFG FOR 2240 “(Lymph)Angiogenesis and Cellular Immunity in Inflammatory Diseases of The Eye” (S. Siebelmann, C. Cursiefen;; EU COST BM 1302 “Joining Forces in Corneal Regeneration” (B. Bachmann, C. Cursiefen, S. Siebelmann). EU STRONG FP7 (C. Cursiefen). EU EFRE NRW (B. Bachmann, S. Siebelmann). EU ARREST BLINDNESS (C. Cursiefen, B. Bachmann,, DFG MA 5110/5-1 (M. Matthaei), FORTUNE Program University of Cologne (M. Matthaei), EU EFRE NRW (S. Siebelmann, B. Bachmann).

The authors have no conflicts of interest to disclose.

C. Cursiefen and B. Bachmann performed surgery and had the idea for the novel technique. S. Siebelmann, M. Matthaei, and A. Händel wrote the manuscript and analyzed the data. All authors reviewed the manuscript.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

B. Bachmann and C. Cursiefen shared senior authorship.

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Received December 12, 2018

Received in revised form February 26, 2019

Accepted March 07, 2019

Online date: April 17, 2019

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