Muraine Sutures for Hydrops in Patients After Penetrating Keratoplasty

To report the clinical characteristics of 7 cases of corneal hydrops after penetrating keratoplasty (PKP) for keratoconus and the postoperative results for 6 of these patients treated with predescemetal sutures (also known as Muraine sutures).

We conducted a retrospective cohort study of all patients who presented at our center with secondary hydrops after PKP for keratoconus from 2023 to 2025.

Seven patients (6 male) presented with corneal hydrops on average 26.8 years (range 20-32 years) after initial PKP. The time between symptom onset and surgery ranged from 1 day to 1 year (mean 12.3 weeks). In all cases, a tear in Descemet membrane could be identified at the temporal or inferotemporal graft-host interface using anterior segment OCT and/or slit-lamp examination. We performed Muraine sutures in 6 patients, all of whom showed significant clearing and reduction of corneal swelling within a few days. Best-corrected visual acuity improved from a mean preoperative value of logMAR 2.17 to logMAR 0.62 at the final follow-up (mean: 10.8 months; range: 6-17 months).

This is the first description of the use and surgical results of Muraine sutures for the treatment of corneal hydrops after PKP. Owing to its rarity and potential confounding with graft failure and late rejection, this condition may be underdiagnosed. In all cases, corneal edema resolved rapidly, resulting in a sustained significant improvement in visual acuity. Therefore, repeat keratoplasty could be avoided in all cases until now.