By Dr Sachin Bawa This week’s case highlights an important complication of keratoconus — corneal hydrops. A young lady (30 years old), known with keratoconus, presented with sudden reduced vision in the right eye. She was initially referred with a possible corneal ulcer. Her background included scleral contact lens wear, with decent visual acuity. Clinical findings showed an oedematous right cornea, with the anterior segment OCT showing oedema in the stroma. A diagnosis of hydrops was made. UVAR) 0.05 ph 0.2 AVAL)0.7 Pachymetry R)244um Her corneas were noted to be very thin, making her unsuitable for corneal cross-linking. She had been managing well with scleral lenses prior to this event. Treatment of the hydrops included the injecting of sulfur hexafluoride (SF6) gas into the anterior chamber. The gas acts as a tamponade, helping to seal the break in Descemet’s membrane. Picture 3 shows her 1 day post op. Historically, hydrops were managed with sodium chloride eyedrops and antibiotic eyedrops. These cases often progressed to corneal scarring, with many patients ultimately requiring a full-thickness corneal transplant. In this case, intervention with SF6 gas injection saved the patient from a corneal transplant. SF6 gas is known to expand and can remain in the eye for approximately 7–14 days, and can assist in expelling the fluid from the cornea and promote healing. A great reminder that timely intervention can completely change the trajectory of these patients Picture 1: Cornea pre-op Picture 2: Cornea post-op picture 3: Slit lamp photo of right eye 1 day post op showing gas bubble.