Intracameral Gas Injection Research Articles

Compression sutures: A rescue to failed intracameral gas injection in massive non-resolving corneal hydrops of long duration in advanced pellucid marginal corneal degeneration (PMCD)

To describe the application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of pellucid marginal corneal degeneration with a large Descemet membrane (DM) tear. Corneal hydrops is a complication of conditions such as keratoconus (KC), pellucid marginal corneal degeneration (PMCD), and keratoglobus. Intracameral gas injection in the form of sulfur hexafluoride (SF6) or perfluoro propane (C3F8) has been known to shorten the recovery period by tamponading the break. The application of corneal sutures to approximate the widely separated ends of the DM tear may also be performed. All these are management options described for acute hydrops. We report two cases of application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of more than 2 months duration in PMCD with a large DM tear. Full-thickness corneal compression sutures and intracameral gas injection can restore the imperviousness of posterior stroma after hydrops. This technique is safe and effective for faster resolution of corneal edema post hydrops and early visual rehabilitation.

Surgical Management of Corneal Hydrops: Case Series

Descemet’s membrane (DM) rupture/detachments have traditionally been treated conservatively, with limited efficacy and a long rehabilitation period that significantly affects patients’ vision and quality of life. Although there are no established gold standards for the timing and nature of treatment, with this series of 4 cases we aimed to highlight the importance of the current optimal intervention methods. The first two patients were treated with anterior chamber injection of isoexpansile 14% C3F8 due to acute hydrops associated with keratoglobus in the first case and keratoconus in the second case. The third patient had keratoglobus and chronic hydrops complicated by multiple stromal clefts detected on anterior segment optical coherence tomography, and the fourth patient had a chronic broad DM detachment which occurred after cataract surgery. Both of these patients were treated with intracameral C3F8 injection together with corneal compressive sutures. In all four cases, DM reattached completely and effectively with surgical intervention. Surgical management of DM rupture/detachment with intracameral gas injection and compressive corneal sutures seems to provide fast symptomatic relief and less healing-related corneal scarring with better visual rehabilitation, and may alleviate the need for corneal transplant surgery in this group of patients.

A case of old total Descemet membrane detachment due to ophthalmic viscosurgical device with clear cornea

We report a case of a large bullous descemet membrane detachment (DMD) following inadvertent injection of ophthalmic viscoelastic device in the supradescemetic space. A 27 years old male with juvenile open-angle glaucoma underwent trabeculectomy in the right eye followed by anterior chamber reformation. He developed DMD for which intracameral gas injection failed twice. He presented with complaints of blurring of images in that eye. Examination revealed a bullous DMD without any corneal edema, confirmed by anterior segment optical coherence tomography (ASOCT). Microscope-integrated intraoperative OCT (mi-OCT) guided drainage with intracameral gas injection was done following which the detachment settled completely.

Treatment of Acute Corneal Hydrops With Combined Intracameral Gas and Approximation Sutures in Patients With Corneal Ectasia.

To assess the efficacy and safety of combined intracameral sulfur hexafluoride and full-thickness corneal sutures in the treatment of acute corneal hydrops (CH). This is an uncontrolled series of cases with keratoconus (KC), keratoglobus (KG), and pellucid marginal degeneration that presented with CH of recent onset. Thirteen patients completed the study. The mean corneal thickness before treatment was 1,310 (Equation is included in full-text article.)556 μm, which significantly reduced to 660 ± 148 μm at week 1 postoperatively (P = 0.001). It took 11.5 ± 6.5 days for corneal edema to resolve with a minimum and maximum of 5 and 24 days, respectively. Corrected distance Snellen visual acuity (CDVA) significantly improved from 0.04 ± 0.03 before treatment to 0.08 ± 0.06 at week 1 (P = 0.035) and continued to improve through month 1 [(0.11 ± 0.05), P = 0.007] and month 3 [(0.15 ± 0.08), P = 0.002]. No patient needed re-treatment with gas injection, and no complication was detected during the follow-up period. Combined intracameral gas injection and approximation sutures are probably effective and safe for the treatment of acute CH. This treatment results in rapid recovery with very rare complications.

A rare case of delayed post-operative migration of intracameral perfluoropropane into pre-descemet space causing a re-detachment of descemet membrane

Abstract Purpose To report a case of re-detachment of descemet membrane subsequent to delayed post-operative migration of intracameral perfluoropropane (C3F8) into the pre-descemet space. Methods A post-phacoemulsification descemet membrane detachment (DMD) was treated by performing descemetopexy using intracameral C3F8 (14%). The descemet membrane was attached on the first post-operative day and there was a single intracameral gas bubble. However, at one week, there was a second gas bubble noted in the pre-descemet space and the descemet membrane had detached again. A stromal vent incision was used to release the C3F8 gas in pre-descemet space and intracameral C3F8 was injected again to facilitate attachment. Result Slit lamp evaluation revealed an attached descemet membrane on the first day following the stromal vent incision with repeat intracameral gas injection. At one week, the corneal edema cleared and best-corrected visual acuity (BCVA) improved to 20/40. Conclusion Delayed post-operative migration of intracameral C3F8 may occur causing a re-detachment of the descemet membrane. Stromal vent incisions can be used to drain pre-descemet gas bubble and re-injection of C3F8 intracamerally to facilitate re-attachment.

Acute Keratoconus-Like Corneal Hydrops Secondary to Ocular Massage Following Trabeculectomy

Purpose: To report a case of acute keratoconus-like corneal hydrops in a patient with long-term ocular massage following trabeculectomy. Methods: Case report and review of medical literature. Results: A rare complication of acute keratoconus-like corneal hydrops occurred in a patient following the use of ocular massage to maintain satisfactory aqueous humor filtration after trabeculectomy. The patient had a history of high myopia but denied previous ocular trauma, allergic disease and a family history of keratoconus. Slit-lamp examination demonstrated keratoconus-like corneal hydrops with formation of epithelial microcystic, and intrastromal cleft. He was diagnosed with acute corneal hydrops in the right eye and received intracameral gas (16% perfluoropropane) injection. On 5 months follow-up, the corneal edema was significantly improved. Conclusions: There may be a contributory relationship between the long-term post-trabeculectomy massage and the development of acute corneal hydrops. When prescribing therapeutic massage, patients should be followed up carefully to monitor for unexpected complications.

Corneal Hydrops in Keratoconus

ABSTRACT Purpose The purpose of this review is to outline the etiology, clinical features, and management of acute corneal hydrops (CH) in cases of keratoconus (KC). Recent findings The advent of newer investigative modalities like ultra biomicroscopy, anterior segment optical coherence tomography and confocal microscopy has contributed toward the diagnosis, treatment planning and following the course of therapy in cases of acute hydrops. Summary Corneal hydrops is an acute complication of keratoconus which in most instances resolves spontaneously. However, prolonged corneal edema can lead to complications, such as corneal neovascularization which can jeopardise a future corneal graft. Hence, timely intervention is required in most cases to prevent such complications as well as for early visual rehabilitation. Intracameral gas injection is the most commonly performed surgical procedure for hydrops. Modifications in surgical technique can help to tackle difficult situations. How to cite this article Maharana PK, Nagpal R, Sharma N. Corneal Hydrops in Keratoconus. Int J Kerat Ect Cor Dis 2015;4(2):52-55.

Descemet´s membrane detachment 16 years after PK and 10 months after phaco

Abstract Purpose The purpose of this paper is to present an unusual case of DMD and analyze this complication Methods A 57‐year‐old woman, who had bilateral keratoconus, underwent three penetrating keratoplasties (PK) on her RE in 1981, 1993 and 1995 resulting in ptisis bulbi. In her LE she underwent two PK (1981, 1994) follow by arcuate incisions (1995) and an uneventful phacoemulsification in 2007. 10 months after cataract surgery, she begun with blurred vision, the BCVA was 20/400 and was seen by 3 ophthalmologists who made the diagnosis of endothelial failure and suggested a new PK or a DSAEK. We performed an Optical Coherence Tomography, diagnosing a complete Descemet´s membrane detachment (DMD). An intracameral gas injection of C3F8 at 16% was performed in the operating room, and the patient was instructed to maintain a supine position. After 24 hours VA improved to 20/80 and after 72 hours 20/30 UCVA. A small bubble was present in the anterior chamber for more than 3 weeks. One month later she achieved 20/20 with Contact Lens. During the first year after reattachment it was necessary to change the CL due to an increasing with the rule astigmatism from 3D to 5D. Results Two years after gas injection BSVA is 20/25 because she is no longer using CL, Descemet´s membrane still remains well attached, even thought we realized that there was a trend to steepen the vertical meridian due to the widening of a nasal arcuate incision, that we think was the origin of the DMD. Conclusion DMD is a rare complication of Phacoemulsification, seen immediately after the surgery. So far there has not reported any complete DMD after phaco after PK. We think that it is mandatory to perform a corneal OCT in all cases of PK and stromal edema; it could probably be a DMD.

Treatment of acute corneal hydrops with intracameral C3F8 in a patient of pellucid marginal degeneration with keratoglobus

We report the use of perfluoropropane (C(3)F(8)) gas for the treatment of acute hydrops with intrastromal cleft in a case of pellucid marginal degeneration with keratoglobus. Acute hydrops in a 36-year-old man with pellucid marginal degeneration with keratoglobus was treated with intracameral injection of 0.3 mL isoexpansile C(3)F(8) (14%). Reduction in corneal haze was seen beginning from the third postoperative day. Significant clearing had taken place by the end of the second week with the closure of intrastromal cleft. Best corrected visual acuity improved from finger counting at 1 foot preoperatively to 6/18 after 2 weeks. There was no postoperative rise in intraocular pressure or cataract formation. Intracameral injection of C(3)F(8) may possibly be a viable treatment option for acute hydrops in a case of corneal ectasia. Larger studies are required to clarify the role of intracameral gas injection in the treatment of acute hydrops in corneal ectasia.

A Combined Technique for Surgical Repair of Descemet’s Membrane Detachments

Descemet's membrane detachments are an uncommon complication after cataract surgery that can result in severe visual loss. A combined technique of intracameral gas injection and transcorneal suturing for the repair of Descemet's membrane detachments is described. In this interventional case series, four cases of Descemet's membrane detachments with associated corneal edema observed following cataract surgery were successfully repaired using a combined technique of intracameral gas injection and transcorneal suturing. In all cases, Descemet's membranes were successfully reattached using the aforementioned technique. In three cases, the associated corneal edema resolved postoperatively. In the fourth case, the patient required a penetrating keratoplasty for persistent corneal edema despite immediate anatomical success following reattachment. Combined intracameral gas and transcorneal suturing appears to be an effective technique in the repair of Descemet's membrane detachments. Early intervention may prevent persistent or recurrent corneal edema.

A new technique for repairing descemet membrane detachments using intracameral gas injection.

Descemet membrane detachments are not uncommon following cataract surgery, and large and extensive detachments can have an impressive presentation, with severe corneal edema and marked reduction in visual acuity. Traditional treatment regimens have included observation (with the hopes of spontaneous resolution), anterior chamber injections of air or viscoelastic, transcorneal suturing, and even corneal transplantation for persistent cases. During the past few years, intracameral injection with either sulfur hexafluoride (SF6) or perfluoropropane (C3F8) gas has gained increasing acceptance as an efficient and effective treatment option for Descemet membrane detachments. Previously described techniques of gas injection have required corneal and paracentesis incisions; sterile blades, cannulas, and other instruments; and occasionally, an operating room setting. We describe a simple, safe, and effective technique for intracameral gas injection that can be performed by one person at the slitlamp microscope or in a minor operating room with minimal equipment.