**18. Conclusion**

Management of acute hydrops influences a long-term visual outcome. ASOCT provides a superior insight into the pathogenesis of acute hydrops. An early intervention is essential for preventing the vascularization of the corneal scar and eventually improving the prognosis of penetrating keratoplasty. Compression sutures, intra cameral gas, and a combination of both are efficient techniques described in the literature with a proven efficacy in hastening the resolution of the corneal edema. DALK and mini-DMEK are highly skillful procedures with questionable reproducibility by multiple surgeons. Prevention of acute hydrops should be a primary goal of all corneal surgeons in the future. An early identification and management of progressive keratoconus, prevention of eye rubbing, and avoidance of the professional sports may decrease the incidence of acute hydrops.

**11**

**Author details**

Praveen Subudhi\*, Sweta Patro and Nageswar Rao Subudhi Ruby Eye Hospital, Berhampur, Ganjam, Odisha, India

\*Address all correspondence to: subudhipraveen@gmail.com

provided the original work is properly cited.

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Acute Hydrops and Its Management*

*DOI: http://dx.doi.org/10.5772/intechopen.94592*

*Acute Hydrops and Its Management DOI: http://dx.doi.org/10.5772/intechopen.94592*

*Eyesight and Imaging - Advances and New Perspectives*

before advocating this procedure.

**17. Mini-DMEK**

**18. Conclusion**

Anterior lamellar keratoplasty [66] in the pretext of acute hydrops is a difficult and complex procedure. Susan et al. recommended a modified DALK method for the treatment of acute hydrops. Small aliquots of air are injected into the stroma, immediately above the predescemeticdua layer and away from the site of the descemet rupture. Subsequently, a lamellar dissection with the help of a blunt crescent is performed carefully in the peripheral cornea, while avoiding the site of the DM tear initially, and then dissected at the center by slowly peeling the stroma. A donor cornea of the same size or 0.25 mm oversize is placed over the raw recipient corneal surface and anchored with the help of twelve or sixteen 10–0 nylon sutures. This averts the two-step procedure, which is normally adopted for acute hydrops, and thus, the visual rehabilitation is gained with a single procedure. However, because of edematous cornea, the risk of augmentation of the DM tear is increased and locating a correct plane for dissection becomes difficult for the surgeons. Therefore, surgeons are advised to become well-versed with anterior lamellar keratoplasty

It is another [67] procedure described in literature. Bachmann and associates described a novel technique of replacing the torn DM with a well-circumscribed donor DM. In this technique, the peripheral torn DM is trimmed and stripped up to the center of the cornea. But the crux of the matter here is that all the maneuvers are performed with an intraoperative OCT-enabled microscope. The donor DM is prepared depending on the defect and is introduced into the anterior chamber with the help of the lens cartridge. Rolled DM enters into the anterior chamber and is unrolled with the help of 2 Sinskey hooks by pressing one end and ironing the other end of corneal lenticule over the anterior corneal surface. Determination of the correct orientation of the lenticule in the anterior chamber is essential for surgeons, which is not possible with a routine microscope because the visibility of the anterior chamber remains poor. With the dense corneal edema, this procedure is highly inappropriate in the routine clinical settings. Hence, approaching through the anterior surface of cornea rather than posterior corneal surface is preferable.

Management of acute hydrops influences a long-term visual outcome. ASOCT

provides a superior insight into the pathogenesis of acute hydrops. An early intervention is essential for preventing the vascularization of the corneal scar and eventually improving the prognosis of penetrating keratoplasty. Compression sutures, intra cameral gas, and a combination of both are efficient techniques described in the literature with a proven efficacy in hastening the resolution of the corneal edema. DALK and mini-DMEK are highly skillful procedures with questionable reproducibility by multiple surgeons. Prevention of acute hydrops should be a primary goal of all corneal surgeons in the future. An early identification and management of progressive keratoconus, prevention of eye rubbing, and avoidance

of the professional sports may decrease the incidence of acute hydrops.

**16. DALK**

**10**
