Using intracameral vital dye as a guide for venting incision in acute corneal hydrops

To introduce a new surgical technique for the localization of corneal bulla to drain a massive corneal hydrops.

Four consecutive cases with acute large protruded hydrops were selected. A limbal paracentesis was made via 15° blade. Afterward, trypan blue with a concentration of 0.1% was injected into the anterior chamber. Upon pooling trypan blue in the bulla, the surgeon immediately marked the primary site of stromal staining before further spreading of the dye. Anterior chamber irrigation was then carried out using balanced salt solution, and the excess of trypan blue was washed out. Subsequently, the surgeon made a beveled venting incision to decompress bulla via 15° blade resulting in a stream of dye egressed from the venting incision. At the end of the surgery, 20% diluted SF₆ was injected into the anterior chamber.

Postoperatively, Descemet's membrane was attached up to the second postoperative day. The corneal edema was resolved up to 3 weeks. Contact lens-corrected visual acuity was improved in all cases.

Venting incision under the guide of injected trypan blue into the anterior chamber combined with intracameral SF₆ injection could be effectively used for a large acute hydrops. This technique could prevent other interventions like passing full-thickness corneal suturing and subsequent complications.