Acute Hydrops of the Cornea Complicating Keratoconus

Rychener, Ralph O.; Kirby, Daniel B.

doi:10.1001/archopht.1940.00870020118011

Cited by 11 publications

(5 citation statements)

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“…According to the current hypothesis on hydrops formation, KC progression causes the posterior cornea to “overstretch”, resulting in Descemet membrane rupture and a secondary hydrops. 1,2,10–12 However, our observations may suggest that a primary defect in the posterior cornea may not be the initial cause for stromal swelling in at least 2 of these cases because there was no detectable break in Descemet membrane in these eyes.…”

Section: Discussionmentioning

confidence: 67%

Acute Hydrops After Bowman Layer Transplantation for Keratoconus May Indicate that Descemet Membrane Rupture Is Secondary to Hydrops

Musayeva

Santander-García

Quilendrino

et al. 2021

Cornea

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Purpose:The aim of this study was to review the postoperative course and imaging features of 7 eyes that presented with corneal hydrops after Bowman layer (BL) transplantation was performed for advanced keratoconus to determine the potential mechanisms of hydrops formation.Methods:A retrospective analysis was performed of 7 eyes of 5 patients with advanced keratoconus that underwent midstromal BL transplantation at 2 tertiary referral centers and developed acute corneal hydrops on average 64 (±30) months (range 14–104 months) postoperatively. Corneal tomography and anterior segment optical coherence tomography (AS-OCT) images were reviewed to document the postoperative and posthydrops course.Results:For all eyes, the post-BL transplantation course was uneventful until hydrops development. Despite stable postoperative topographies in 5 of 7 eyes, eyes developed hydrops with typical hypodense areas on AS-OCT that were limited to the stromal layers posterior to the BL graft. With AS-OCT (6/7 eyes), 2 eyes showed a break in Descemet membrane, whereas Descemet membrane was intact across the cornea in 2 eyes; in 2 eyes, the images were inconclusive. All patients admitted to continued eye rubbing, and all but 1 had a clinically significant allergy and/or atopic constitution. Most eyes (5/7) showed a relatively quick (visual) recovery within 1 to 4 months after hydrops.Conclusions:Hydrops formation in keratoconic corneas after midstromal BL transplantation may indicate that a break in Descemet membrane is secondary to hydrops development (and not vice versa). With a midstromal BL graft in situ limiting hydrops dimensions, resolution of the hydrops seemed relatively quick with recovery to prehydrops visual acuity in most eyes.

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Section: Discussionmentioning

confidence: 67%

Acute Hydrops After Bowman Layer Transplantation for Keratoconus May Indicate that Descemet Membrane Rupture Is Secondary to Hydrops

Musayeva

Santander-García

Quilendrino

et al. 2021

Cornea

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“…[32] The disease is confined to the central and paracentral regions and rarely manifests in the peripheral region in case of coexistent pellucid marginal degeneration [33]. In addition to a defective vision, pain and redness are the typical symptoms of this disease [34]. The patients exhibit a definite history of persisting poor vision since childhood and experience progressive vision loss [35].…”

Section: Clinical Examination and Manifestationsmentioning

confidence: 99%

Acute Hydrops and Its Management

Subudhi¹,

Patro²,

Subudhi³

2020

Eyesight and Medical Image Cognition - Recent Advances and New Perspectives [Working Title]

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Acute hydrops is a well-known complication of keratoconus. It usually manifests as sudden onset loss of vision. Mostly presents in the pubertal age group. Allergic conjunctivitis associated with eye rubbing is the most substantial risk factor. Primary pathology being stromal lysis, which triggers the progression of cone, causing an undue stretch on Descemet Membrane, eventually resulting in its splitting and stromal imbibition of aqueous through these ruptures. Clinical signs are circum-cillary congestion and thick/edematous cornea with obscuration of the anterior segment. Conservative therapy delays wound healing; hence early surgical intervention is recommended globally for faster resolution of stromal edema. Long-standing corneal edema mounts to corneal perforation and neovascularisation of cornea. Compressive suture, non expansile intracameral gas injection, Deep anterior lamellar keratoplasty, and mini Descemet membrane keratoplasty are various management modalities reported in literature. Acute hydrops could be well prevented with early identification of progressive keratoconus and halting its progression.

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“…Der akute Hydrops beschreibt ein akutes Ödem durch plötzlichen Einriss der Descemet-Membran (DM) meist in Assoziation mit einer voranschreitenden Keratektasie [1]. Beim spontan auftretenden akuten Hydrops verhindert die Rigidität der DM, dass sie der fortschreitenden Ektasie des Stromas folgt, wodurch eine erhöhte Spannung auf die DM zur Ruptur führt.…”

Section: Introductionunclassified

“…Acute corneal hydrops is an acute edema caused by a sudden rupture in the Descemet membrane (DM), mostly in association with preexisting corneal ectasia [1]. In spontaneous acute corneal hydrops, the rigidity of the DM prevents it from following the advancing corneal ectasia, generating elevated tension on the DM, which causes the rupture.…”

Section: Introductionmentioning

confidence: 99%

Der korneale Hydrops – Ursachen und moderne Therapieansätze

Bachmann

Matthaei

Schlereth

et al. 2023

Klin Monbl Augenheilkd

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ZusammenfassungDer akute Hydrops bezeichnet ein plötzliches Hornhautödem, das durch den Einriss der Descemet-Membran (DM) häufig bei fortschreitender Keratektasie verursacht wird. Er führt zu einer plötzlichen Visusminderung, Schmerzen und Fremdkörpergefühl sowie zu einem gesteigerten Blendungsempfinden. In der Regel heilt der akute Hydrops innerhalb von Monaten narbig ab, jedoch kann es auch zu Komplikationen wie Hornhautperforation, infektiöser Keratitis und Hornhautvaskularisationen kommen. Die Prävalenz bei Keratokonuspatienten liegt bei 2,6 – 2,8%. Risikofaktoren sind die Keratoconjunctivitis vernalis, die atopische Dermatitis, hohe Keratometriewerte, männliches Geschlecht sowie Augenreiben. Eine Keratoplastik sollte in der akuten Phase vermieden werden. Die Prognose des Transplantates ist reduziert und nach narbiger Abheilung des Hydrops kann das Tragen von Kontaktlinse oder Brille u. U. wieder möglich sein. Eine alleinige konservative Therapie mit benetzenden und entquellenden Tropfen, prophylaktischen antibiotischen Augentropfen zur Vermeidung einer Superinfektion und topischen Steroiden galt lange Zeit als die einzig mögliche Behandlungsform. Die narbige Abheilung und Entquellung unter konservativer Therapie dauert im Mittel jedoch über 100 Tage. Mittlerweile gibt es unterschiedliche chirurgische Strategien, die die Heilungs- und damit die Leidensphase der Patienten bis auf wenige Tage rapide verkürzen. Bei Lösung der DM ohne Spannung kann eine simple Gaseingabe in die Vorderkammer bereits zur Wiederanlage und damit zur fast sofortigen Entquellung der Hornhaut führen. Wenn die DM unter Spannung steht, kann durch prädescemetale Nähte in Kombination mit einer Gaseingabe in die Vorderkammer ein Abflachen der Hornhaut und eine Wiederanlage der DM erreicht werden. Die Mini-Descemet Membrane Endothelial Keratoplasty (Mini-DMEK) erlaubt den nahtfreien Verschluss des DM-Defektes durch Transplantation eines kleinen (< 5 mm) Transplantates. Bei besonders großen DM-Rissen und sehr ausgeprägtem Hydrops kann es nach Anlage von prädescemetalen Nähten zu Fadenlockerungen und Rezidiven kommen. Die Mini-DMEK kann dann zum dauerhaften Abheilen führen, muss im Gegensatz zur einfachen Hornhautnaht aber meist in Allgemeinanästhesie und unter intraoperativer OCT-Kontrolle durchgeführt werden. Die sehr guten Ergebnisse in Bezug auf die schnelle Heilung des Hydrops belegen, dass bei den allermeisten Betroffenen eine chirurgische Therapie sinnvoll ist und zügig eingeleitet werden sollte.

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Acute Hydrops of the Cornea Complicating Keratoconus

Cited by 11 publications

References 1 publication

Acute Hydrops After Bowman Layer Transplantation for Keratoconus May Indicate that Descemet Membrane Rupture Is Secondary to Hydrops

Acute Hydrops After Bowman Layer Transplantation for Keratoconus May Indicate that Descemet Membrane Rupture Is Secondary to Hydrops

Acute Hydrops and Its Management

Der korneale Hydrops – Ursachen und moderne Therapieansätze

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