Air / gas injection for corneal hydrops, keratoconus, pellucid degeneration - A State of Sight #45

Описание: Corneal hydrops, which is a break in the inner layers of the cornea causing swelling and clouding of the cornea, can occur in patients with keratoconus, pellucid marginal degeneration, or keratoglobus. For more info on corneal hydrops, see episode #21 of A State of Sight:    • Corneal hydrops, advanced keratoconus, acu...  

In this episode, Isaac Porter, MD explains how hydrops can be treated by an injection of air or gas into the front part of the eye (the anterior chamber). This treatment may be able to reduce the time for the cornea to clear and for the swelling to disappear, but the process could still take months. Left untreated, hydrops would generally take even longer to clear spontaneously (3 to 4 months or longer).

Surgeons can choose from filtered air or medical grade gases to inject into the eye. The primary gases that have been used are SF6 and C3F8 which both have a long track record of compability with the eye. Retinal surgeons commonly use gases and air in retina reattachment procedures to flatten the retina after a retinal detachment while scarring takes place to achieve permanent attachment. These gases will persist longer in the back part of the eye (vitreous cavity) than they do in the anterior chamber. One of the advantage of the gases over air is that the gases will remain longer, with C3F8 lasting longer than SF6.

Air is also injected into the eye after the corneal transplantation procedures DSEK and DMEK, where the bubble presses against the inner-layer transplant over the first 24 hours before the permanent natural attachment occurs.

In hydrops, the air/gas bubble is injected into the front part of the eye and the patient is instructed to look directly at the ceiling so the bubble will float against the back side of the cornea. This keeps fluid from entering the cornea through the inner layer break and gives the cornea a chance to recover, resurface the inner layer, and clear the swelling. One of the primary risks of the procedure is the air bubble blocking the pupil and causing pressure to rise in the eye. To help avoid this, the pupil may be dilated, or an alternate opening near the outer edge of the iris may be created.

Do you have any questions about this treatment or corneal hydrops in general? Please post below!

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