Acute hydrops in a host cornea after penetrating keratoplasty for keratoconus

Abstract

This report highlights a rare case of acute hydrops in a host cornea that developed 7 years after penetrating keratoplasty (PKP) for keratoconus. We obtained detailed clinical findings of the condition by anterior segment optical coherence tomography (AS-OCT). We believe this is the first report of hydrops localized in the host cornea without causing edema in the graft. In addition, its onset was the earliest observed after keratoplasty [1-4]. Case reportA 37-year-old man had been followed up by a local doctor for keratoconus since 1995. The patient developed acute hydrops in his right eye in 2001 and was referred to our hospital by the local doctor. The acute hydrops improved spontaneously after 2 months. His best corrected visual acuity (BCVA) oculus dexter (OD) with a hard contact lens (HCL) recovered to 1.2. Later, the patient developed acute hydrops OD twice, and his BCVA decreased to 0.2. He underwent PKP in his right eye at our hospital in 2003. In 2005, he underwent PKP in his left eye because of HCL intolerance due to an exacerbation of the keratoconus. In 2009, his BCVA with HCL was 1.5 oculus uterque (OU). The graft and host cornea OU were clear. The corneal endothelial cell density (ECD) was 573 cells/mm 2 OD and 871 cells/mm 2 oculus sinister (OS); the central corneal thickness (CCT) was 610 lm OD and 590 lm OS. The patient revisited our hospital in January 2010 complaining of corneal opacity in the nasal side of the right eye and HCL intolerance. Despite decentration of the HCL to the nasal side, VA OD was 1.2. Although slit-lamp microscopy revealed corneal opacity and thickening of the lower nasal side of the host cornea, the graft was transparent, and no inflammatory or rejection findings were observed (Fig.

Descemet Membrane Detachment After Penetrating Keratoplasty for Keratoconus

“…Late-onset Descemet membrane (DM) detachment has also been described. [7][8][9][10][11] We report an additional seven eyes that developed an acute DM detachment several years after a PK for keratoconus, including an individual with bilateral detachments, and one case that resolved spontaneously. DM detachment was identified at slit lamp examination and confirmed with anterior segment optical computerized tomography (AS-OCT, Casia2, Tomey Corporation, Japan).…”

Management of acute corneal hydrops in ectatic corneal disorders

“…Although it was initially reported in cases of keratoconus (KC) [1] subsequently it has been seen in other corneal ectasias such as pellucid marginal degeneration (PMD) [2], keratoglobus [3], terrien's marginal degeneration (TMD) [4]. This may also occur in cases of keratectasias after surgery such as following laser-assisted in-situ keratomileusis [5], radial keratotomy [6], deep anterior lamellar keratoplasty (DALK) [7] and penetrating keratoplasty [8,9]. In this article, we review the cause, diagnosis, management and outcomes in cases of acute corneal hydrops in corneal ectatic disorders.…”

Bevel toric multicurve rigid gas-permeable lens for keratoconus

“…The small bevel results in reduced tear exchange and induces corneal epithelial disorders and visual disturbance. Although keratoplasty is the best treatment option for patients with severe keratoconus, various postoperative complications, including graft rejection or failure, astigmatism, recurrence of keratoconus in the donor graft, and development of cataracts, glaucoma, or acute hydrops, are described [19,21].…”