A young myopic patient with astigmatism presents with acute red eye, history of frequent spectacle change, and eye rubbing. On examination, corneal hydrops is seen and an intracameral gas injection was performed. What is the likely diagnosis and management procedure shown?

1. A

   Descemet's stripping endothelial keratoplasty (DSEK)

2. B

   Deep anterior lamellar keratoplasty (DALK)

3. C

   Intracameral gas injection with C3F8 for acute hydrops

4. D

   Collagen cross-linking

Appeared in: INI-CET EXAM -2025

Explanation

• The patient's history and symptoms are classic for keratoconus, a progressive thinning and bulging of the cornea.
• Acute corneal hydrops is a known complication of keratoconus, resulting from a tear in Descemet's membrane.
• The procedure shown, an intracameral gas injection (using a gas like C3F8), is a direct treatment for acute hydrops.
• The gas bubble acts as a tamponade, pressing on the tear to facilitate healing and resolution of the corneal edema.

Why Other Options Were Wrong

• Option A: DSEK is a partial-thickness corneal transplant that replaces the endothelium and Descemet's membrane. It is used to treat endothelial dysfunction, such as in Fuchs' dystrophy, not keratoconus, which is primarily a stromal disease.
• Option B: DALK is a deep partial-thickness corneal transplant for advanced keratoconus. It is a major reconstructive surgery, not an emergency procedure for acute hydrops. It may be performed after the hydrops has resolved and scarring has occurred.
• Option D: Collagen cross-linking (CXL) is a therapeutic procedure designed to strengthen the cornea and halt the progression of keratoconus. It is not a treatment for the acute complication of corneal hydrops.

Related Visual

• Visual 1: Diagram - A cross-section of the cornea illustrating a tear in Descemet's membrane with fluid (aqueous humor) entering the stroma, causing edema (hydrops).
• Visual 2: Animation - Showing an intracameral gas injection and how the buoyant gas bubble presses against the posterior cornea to seal the tear when the patient is in a supine position.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of acute corneal hydrops in keratoconus to guide bedside assessment, documentation, and the next nursing action.
• Recognizing acute corneal hydrops in a patient with known keratoconus is critical, as it is an ophthalmic emergency requiring prompt referral.
• Nursing care post-procedure involves instructing the patient to maintain a strict supine (face-up) position for several days to ensure the gas bubble correctly tamponades the tear.
• Patient education should include signs of complications like increased intraocular pressure (severe pain, headache, nausea) or infection.

How to Approach the Question

• First, analyze the patient's history and symptoms (young, myopic, astigmatism, eye rubbing, frequent spectacle changes) to identify the underlying diagnosis, which is classic for keratoconus.
• Next, identify the acute event described: 'acute red eye' and 'corneal hydrops'. This points to a complication, not a routine treatment.
• Examine the intervention mentioned in the stem and shown in the image: 'intracameral gas injection'.
• Evaluate the options. Option C directly names the procedure performed for the specific acute complication (hydrops).
• Eliminate the other options by identifying their purpose: DSEK is for endothelial disease, DALK is a transplant for advanced keratoconus (not an acute treatment), and CXL is to prevent progression in early disease.

Concept Tested & Keywords

• Concept Tested: Management of acute corneal hydrops in keratoconus.
• Stem keywords: myopic, astigmatism, acute red eye, corneal hydrops, intracameral gas injection
• Lead-in keywords: likely diagnosis, management procedure
• Clinical cues: The combination of young age, progressive myopia/astigmatism, and eye rubbing strongly suggests keratoconus.
• Clinical cues: Acute red eye with corneal hydrops points to an acute complication, not a routine procedure.

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