This article reports a novel surgical technique of partial-thickness compression sutures without descemetopexy with air or gas for the management of acute hydrops in keratoconus. Two patients presented with localized corneal edema with a Descemet membrane (DM) tear in the left eye. Tomography of the right eye revealed localized steepening with increased maximum keratometry and decreased central pachymetry. They were diagnosed with keratoconus in the right eye and acute corneal hydrops (ACH) in the left eye. Compression sutures were passed through the stroma without touching the DM. The anterior chamber was not entered at all at any point during the surgery. Resolution of edema was noted intraoperatively itself. Further resolution of edema was noted from the first postoperative day which markedly reduced within the first week. A corneal scar with no edema was seen at six weeks. In both the patients, vision at presentation was counting fingers close to face which improved to 20/60 and 20/50, respectively, at the last visit.

This case report describes a case of acute corneal hydrops (ACH) within 4 days following collagen cross-linking that was done to arrest the progression of keratoconus in a 15-year-old girl. She developed pain, redness, and watering in the left eye within 4 days of undergoing an uneventful bilateral corneal collagen cross-linking. The diagnosis of ACH was made and was managed medically with a course of topical steroids. A large fluid-filled stromal pocket with iris adhering to the posterior surface was observed that resolved with stromal scarring after the treatment. Thus, ACH may be precipitated by cross-linking and needs to be managed appropriately.