Compression sutures
A split in the DM, Dua’s layer, and endothelium allows the aqueous to enter the cornea, leading to edema in acute corneal hydrops
Conservative management may take 2-4 months for spontaneous resolution of edema
Large tears may take even longer or need keratoplasty
Longer duration of edema increases the chances of vascularization, which in turn increases the possibility of graft rejection in subsequent keratoplasty
Compression sutures, both partial and full-thickness, with descemetopexy can be done
Preoperative planning
The site of DM tear is identified on slit lamp examination and AS OCT
Surgery
10-0 nylon sutures are passed through the stroma, perpendicular to the tear in the DM
The sutures are taken across the area of corneal edema, at the junction of the edematous and clear cornea
The lateral extents are sutured first followed by central sutures
The length and number of the sutures depend on the extent of edema and the size of the tear
Intraoperative resolution of corneal edema can happen and in those cases, the loose sutures need to be retaken
The sutures are buried away from the visual axis and BCL is placed after ensuring water tightness
POST-OPERATIVELY:
Tapering dose of steroids and antibiotics
Loose sutures removed as and when required
Remaining sutures at 3 months post op
CL trial can be done after suture removal to determine BCVA
Image from Rajan Eye Care Hospital
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