Therapeutic Outcomes of Three Surgical Approaches for Acute Corneal Hydrops

PURPOSE: To compare therapeutic outcomes of three surgical approaches for acute corneal hydrops (ACH): compression sutures combined with intracameral air injection (CSAI), CSAI followed by deep anterior lamellar keratoplasty (DALK), and penetrating keratoplasty (PKP). METHODS: This study enrolled 26 patients (26 eyes) into three groups: CSAI-only (7 eyes), CSAI+DALK (14 eyes), and PKP (5 eyes). Demographics; best-corrected visual acuity (BCVA), corneal edema area, central corneal thickness (CCT), corneal curvature during the acute phase; resolution time after CSAI; BCVA, corneal curvature, CCT, astigmatism at final follow-up; and complications were collected. RESULTS: < 0.05): CSAI-only (0.60 ± 0.15), CSAI+DALK (0.34 ± 0.16), PKP (0.15 ± 0.09). Among 17 eyes planned for DALK, Descemet's membrane perforation occurred in 5 eyes. One PKP case had graft rejection, no long-term complications in the other two groups. CONCLUSIONS: CSAI shortens ACH duration but offers limited visual improvement, serving as a phased treatment. DALK after CSAI resolution significantly improves BCVA and reduces graft rejection risk, making CSAI+DALK a preferred balanced approach. PKP provides the greatest BCVA but carries higher rejection risk, reserved for non-suitable cases of other options.