Acute Hydrops in Keratoconus Masquerading as Acute Corneal Transplant Rejection

Wickremasinghe, Sanj; Pullum, Kenneth W.; Buckley, Roger

doi:10.1097/01.ico.0000208824.55485.6a

Cited by 12 publications

(8 citation statements)

References 9 publications

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“…the DM, scrolling of the free edges, and stromal edema. These findings are similar to those in patients with hydrops in non transplanted corneas [5].…”

Section: Casesupporting

confidence: 89%

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The role of anterior segment optical coherence tomography (OCT) in the diagnosis of corneal hydrops post penetrating keratoplasty in a patient with keratoconus

AL-Jawhara¹,

Majed²

2019

Clin Med Invest

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Objectives:(1) To report the case of a patient post penetrating keratoplasty (PKP) for keratoconus and developed corneal hydrops near the junction between the donor cornea and the host cornea; (2) to show the value of optical coherence tomography (OCT) of the anterior segment in diagnosing such cases; and (3) to review the literature about acute corneal hydrops post PKP.Case: A 52-year-old woman who post PKP in her right eye for keratoconus 32 years ago. She was referred to Anterior segment clinic in King saud university hospital with the diagnosis of endothelial rejection. She had been experiencing blurred vision and photophobia in her right eye for 5 days.Results: Examination of the right eye showed a visual acuity of 20/400, 12 mm Hg intraocular pressure, no ciliary injection, and quiet conjunctiva. She had a large (about 9 mm) corneal graft with an inferotemporal area of ectasia and stromal edema near the junction of the donor cornea and the host cornea. There were neither keratic precipitates nor anterior chamber reaction. The lens showed early nuclear sclerosis cataract. Anterior segment OCT showed Descemet membrane detachment. In her left eye, the patient had a visual acuity of 20/200, normal intraocular pressure, and corneal ectasia, with apical scarring. The lens showed early nuclear sclerosis cataract. Examination of the fundus revealed normal findings in both eyes. Conclusions:Acute corneal hydrops post PKP is a rare condition that should be included in the differential diagnosis of graft edema in a quiet eye. Anterior segment OCT is a very helpful tool in diagnosing this condition, eliminating the use of unnecessary steroid therapy.

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“…the DM, scrolling of the free edges, and stromal edema. These findings are similar to those in patients with hydrops in non transplanted corneas [5].…”

Section: Casesupporting

confidence: 89%

“…Wickremasinghe, et al [5] looked at the histology of the donor button in patients who had hydrops after PKP, which revealed breaks in…”

Section: Discussionmentioning

confidence: 99%

The role of anterior segment optical coherence tomography (OCT) in the diagnosis of corneal hydrops post penetrating keratoplasty in a patient with keratoconus

AL-Jawhara¹,

Majed²

2019

Clin Med Invest

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“…Rarely, it can occur in a corneal graft and is frequently an extension of a break in Descemet's membrane from the host cornea to the donor graft. This has been reported in two separate case reports 23…”

Section: Introductionmentioning

confidence: 58%

Acute hydrops in the donor cornea graft in non-keratoconus patients

Cason

Yiu

2013

Middle East Afr J Ophthalmol

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A 44-year-old Hispanic male and 91-year-old Caucasian male presented to the clinic with acute vision loss and pain years after penetrating keratoplasty (PKP). Neither patient had a history of keratoconus. Both patients had a history of eye rubbing and intraocular device present in the anterior chamber. The first patient had a history of a glaucoma drainage tube and the second patient had an anterior chamber intraocular lens implanted. Anterior segment ocular coherence tomography showed deep stromal cystic cavities. Both patients exhibited breaks in the endothelium by ultrasound biomicroscopy and the histopathologic examination after repeat PKP. Those findings were most consistent with acute corneal hydrops in the donor graft.

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“…Lyon et al [3] reported a case of acute hydrops localized in a corneal graft. The remaining five cases developed in the area of the graft-host interface, and corneal edema extended to both the graft and the host cornea [1,2,4]. The onset of hydrops in all six cases occurred between 19 and 33 years after PKP.…”

Section: Commentmentioning

confidence: 94%

“…Only six cases of hydrops after PKP have been reported [1][2][3][4]. Lyon et al [3] reported a case of acute hydrops localized in a corneal graft.…”

Section: Commentmentioning

confidence: 97%

Acute hydrops in a host cornea after penetrating keratoplasty for keratoconus

et al. 2011

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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.

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Acute Hydrops in Keratoconus Masquerading as Acute Corneal Transplant Rejection

Abstract: It is important to differentiate hydrops of the host cornea from acute transplant rejection. This distinction will allow the judicious use of steroids and may allay patient anxiety about possible rejection.

Cited by 12 publications

References 9 publications

The role of anterior segment optical coherence tomography (OCT) in the diagnosis of corneal hydrops post penetrating keratoplasty in a patient with keratoconus

The role of anterior segment optical coherence tomography (OCT) in the diagnosis of corneal hydrops post penetrating keratoplasty in a patient with keratoconus

Acute hydrops in the donor cornea graft in non-keratoconus patients

Acute hydrops in a host cornea after penetrating keratoplasty for keratoconus

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