Case Report: Effective management of acute corneal hydrops with concurrent nystagmus and retinitis pigmentosa: combination of deep lamellar corneal suturing and anterior chamber gas injection.

BACKGROUND: Summarizing the clinical management and prognosis of acute corneal hydrops complicated by nystagmus and retinitis pigmentosa, this study provides a reference for the diagnosis and treatment of similar rare cases.

CASE PRESENTATION: Retrospective collection of data on three adolescent patients admitted to our hospital between December 2024 and October 2025 due to photophobia, eye pain, and tearing. Diagnosed with bilateral keratoconus concurrently with retinitis pigmentosa and nystagmus based on slit-lamp examination, corneal optical coherence tomography, macular optical coherence tomography, corneal topography, and fundus photography. Three patients presented with acute corneal edema due to rapid progression of keratoconus. Upon admission, they underwent deep lamellar corneal suturing in the edematous area combined with anterior chamber gas injection. Postoperative observations included the duration of corneal edema resolution, posterior lamellar closure, and corneal scar formation. The study analyzed the association among these three conditions and explored diagnostic and treatment approaches for keratoconus, nystagmus, and retinitis pigmentosa co-morbidity, along with specific implementation protocols and retinitis pigmentosa. In all three patients, postoperative corneal edema resolved promptly, with subsequent successful healing of the posterior elastic layer. No complications such as corneal perforation or neovascularization occurred. Follow-up examinations 1 to 3 months post-surgery revealed significant improvement in the patient's photophobia and ocular pain symptoms, with only minimal corneal opacities or hazes remaining. Quality of life showed marked enhancement.

CONCLUSION: Deep lamellar corneal suturing combined with anterior chamber gas injection safely and effectively controls acute corneal edema in patients with keratoconus complicated by retinitis pigmentosa and nystagmus. This approach effectively prevents severe complications such as corneal perforation and neovascularization, making it the preferred clinical solution for improving the prognosis of such low-vision patients with acute corneal hydrops.