EC Ophthalmology

Purpose: To report the outcomes of corneal intrastromal injection of autologous blood to address clefts and stromal edema caused by hydrops, to expedite the resolution and reduce its complications.

Methods: This was a retrospective case series of corneal hydrops - due to keratoconus and marginal pellucid degeneration (MPD) - treated with intrastromal injections of autologous blood. The cases have all failed to respond to conservative traditional treatment. A 3.0-cc syringe filled with the patient’s unprocessed, presently collected blood and attached to a 27-gauge needle was used to penetrate the cornea and fill the clefts and corneal edema. The follow-up ended with the resolution of the corneal hydrops. Pre- and postoperative evaluations were meticulously conducted, entailing photographic recording and corneal optical coherence tomography (OCT).

Result: The study evaluated the results of the treatment in 8 eyes, 7 patients. The mean pre-treatment corneal thickness was 1417.50 ± 432 µm (range 796 - 1920 µm). Following treatment, the cornea thickness was 1020 ± 328 µm (range 772 - 1652) at seven days and 762.50 ± 460.44 µm (range 384 - 1853) 30 days post intrastromal injection. There was a significant reduction from pre-op to thirty days after treatment in the cornea thickness of 655.00 ± 527.65 µm (p = 0.010). Six of the eight eyes exhibited a reduction in corneal thickness of over 50% within 30 days post-surgery. The median time to resolution was 4.2 weeks. No intraoperative or postoperative complications were associated with this procedure.

Conclusion: This case series demonstrates that intrastromal autologous blood is a promising and viable treatment option for managing corneal hydrops, particularly when traditional approaches have proven ineffective. The treatment is cost-effective and could be used as an alternative to reduce symptoms and improve quality of life while on the cornea waiting list. Furthermore, this series adds to the literature on OCT findings in corneal hydrops and the intrastromal application of autologous blood to address Descemet membrane (DM) rupture in acute corneal hydrops.

 Keywords: Keratoconus; Hydrops; Autologous Blood; Corneal Graft; Corneal Transplantation

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