Management of acute corneal hydrops secondary to keratoconus with intracameral injection of sulfur hexafluoride (SF6)

Purpose: To report the use of sulfur hexafluoride (SF6) gas in the management of corneal edema caused by acute corneal hydrops secondary to keratoconus. Methods: Nine eyes with acute hydrops secondary to keratoconus managed by SF6 gas injected into the anterior chamber (group 1) were compared to another 9 eyes that were managed conservatively with conventional medical therapy (group 2). Results: Of 9 eyes in group 1, 3 had I injection, 4 had 2 injections, and the remaining 2 had 3 injections into the anterior chamber. All the eyes in group 1 showed an early resolution of corneal edema at 4 weeks. The same was achieved in group 2 at 12 weeks. The central corneal thickness (CCT) in group 1 and group 2 was > 1.0 mm at presentation. The CCT at 3 and 12 weeks in group 1 was 0.99 and 0.65 mm, respectively, whereas CCT in group 2 at 3 weeks was > 1.0 mm and at 12 weeks was 0.991 mm (P = 0.001). The rnean best spectacle-corrected visual acuity (BSCVA) at 12 weeks in group 1 and group 2 was 0.39 and 0.24, respectively (P = 0.016). The results were significant in favor of group 1 over group 2 both in CCT and BSCVA. Conclusion: Early intervention with intracameral SF6 injection is a safe and effective therapy for early reduction of corneal edema in eyes with keratoconus and acute hydrops.