Intraoperative optical coherence tomography-guided compression sutures in acute corneal hydrops - Surgical technique and review of literature.

Purpose: To describe outcomes of the intraoperative optical coherence tomography (iOCT)-guided technique of partial-thickness compression sutures (PTS) in acute corneal hydrops. We also provide a comprehensive review of literature of the outcomes of compression sutures in acute hydrops.

Methods: This study involves prospective interventional case series of patients with keratoconus and acute corneal hydrops. iOCT was used to assess the morphological features of the hydrops, observe surgical dynamics during PTS, titrate the magnitude of suture tightness by observing the stromal compaction and minimisation of intrastromal fluid clefts, and confirm the depth of suture placement (intended at 50-60%). The primary outcome measure was time to resolution of hydrops. Suture removal was planned after documenting stability of corneal thickness.

Results: Seven patients (4 males, 3 females; median age 16 years) underwent iOCT-guided PTS with intracameral air. The time interval between onset of hydrops and PTS ranged from 1 to 12 weeks. The preoperative corneal thickness ranged from 1120 to 2363 mm. The initial depth of suture placement on iOCT was observed to be <50%; progressive stromal compaction and collapse of intrastromal fluid pockets allowed deeper penetration with needle during subsequent suture placement. A decrease in separation of DM from stroma was noted; however, no case had on-table complete DM-stromal reattachment. Complete resolution of hydrops was observed by 2 weeks in all cases. Suture removal was performed in 5 cases at 8-12 weeks.

Conclusion: iOCT helps titrate depth and tightness of compression sutures in real time to achieve on-table stromal compaction and minimization of intrastromal clefts, with fast resolution of acute hydrops.