Hydrops after corneal perforation during manual deep anterior lamellar keratoplasty for keratoconus

Birbal, Rénuka S.; Parker, Jack; Dijk, Korine van; Oellerich, Silke; Dapena, Isabel; Melles, Gerrit R.J.

doi:10.1111/aos.14320

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“…An abnormal and/or weakened stromal anatomy may also explain the development of large ruptures across the posterior cornea in the presence of a break in Descemet membrane because a descemetorhexis performed for endothelial disorders does not seem to cause diffuse stromal disruption, even in the presence of a large graft detachment. 14,15 Furthermore, when lamellar dissection is performed during surgery in a keratoconic cornea, the actual "cone" most often shows very little tissue resistance to the dissection blade, that is, dissection through the thinnest area is often easier than in other areas of the cornea or in a nonkeratoconic cornea, which may also suggest a substantial anatomical change of the central stromal tissue in KC. 16 Another striking finding was that in all eyes studied here, the "hydrops" was limited to the stromal layers posterior to the BL implant (Figs.…”

Section: Discussionmentioning

confidence: 99%

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: 99%