Treatment of Corneal Hydrops With Sulfur Hexafluoride Gas

Abstract

Purpose:: The objective is to look for a new way of treatment for acute corneal hydrops to diminish the time of recovery, inflammation and as a second benefit to avoid corneal neovascularization.Corneal hydrops is a complication caused by ruptures in Descemet membrane. It diminish and clears out as soon as the endothelium covers the defect; it usually takes as long as 2 to 4 months. The ruptures in Descemet can provoke stroma neovascularization between the 6^thweek through 6^th month from the start of hydrops.It has been described that intracameral air injections reapply Descemet. Investigations have used inert gases because of their expansion capacity and mayor half life than air. The sulfur hexafluoride (SF₆) gas is an inert gas, non toxic to endothelium, that is actually being used in vitreous and retina surgery as a tamponade in retinal detachment

Methods:: Descriptive, prospective, longitudinal and experimental study. We included all patients attending the Instituto Fundación Conde de Valenciana in México City, at the cornea service with the diagnosis of Corneal Hydrops (keratoconus) from the 1^st September 2006 trough January 31^st of 2007. Who wish to participate in the study and signed the informed consent. We evaluated the time of onset, time of resolution and corneal neovascularization. Two blinded observers reviewed the clinic photographs taken at the first visit and at day 2, 4, 6 10 and 15 after treatment and compared the evolution of hydrops, clinical diminish of stromal edema. It was recorded the corneal neovascularization previous to treatment and the evolution. It was also evaluated the size of the bubble of SF₆ in the anterior chamber.

Results:: 10 eyes of 10 patients, with corneal hydrops (size between 5 and 9 mm). We injected SF₆ 20% intracameral in average of 60% of the total volume (remained for 5-7 days) the stromal edema disappear in 14 days (10-21) no corneal neovascularization increased was observed, and decreased in diameter for each vessel presented initially. One patient required repeated injection (2 times). One patient had transitory intraocular hypertension resolved with topical medication. No side effects were reported

Conclusions:: Intraocular SF₆ gas injection is an approach for the treatment of corneal hydrops especially in complicated cases where corneal neovascularization may convert to a high risk corneal transplant. A control group and a longer follow up most be required for latter investigations

Keywords: cornea: endothelium • keratoconus • cornea: stroma and keratocytes