Spontaneous corneal hydrops and perforation in keratoconus and pellucid marginal degeneration.
ABSTRACT To report two cases of pellucid marginal degeneration and one case of keratoconus associated with spontaneous corneal hydrops leading either to perforation or imminent perforation, requiring urgent keratoplasty.
Retrospective interventional case series of three patients with noninflammatory peripheral corneal degenerations. A retrospective review was done of the clinical courses, surgical interventions, and pathologic specimens, development of spontaneous hydrops, perforation, need for surgical intervention, and final visual outcome.
Two patients with pellucid marginal degeneration and one with keratoconus developed spontaneous hydrops followed by aqueous leakage through markedly thinned anterior stroma. In one case, the leak site was successfully sealed after three separate applications of tissue adhesive, although the remaining two cases required penetrating keratoplasty.
These cases document the very unusual occurrence of corneal hydrops leading to spontaneous corneal perforation in patients with keratoconus and pellucid marginal degeneration.
Article: Atypical hydrops in keratoconus.[Show abstract] [Hide abstract]
ABSTRACT: To report the clinical presentation, progress and management of atypical acute hydrops. A retrospective case study of three patients with keratoconus, two of whom had previously undergone penetrating keratoplasty. The patients underwent full ophthalmological examination and digital slit-lamp imaging of the cornea throughout the course of the condition. The two patients who had previously undergone keratoplasty had spontaneous hydrops primarily affecting the host bed but in one case extended to the graft inferiorly; however, in the third patient it was traumatic in origin. The Descemet's tear affected the host rim in only one patient, which resolved spontaneously. In another patient, the hydrops was related to an internal dehiscence of the graft-host junction and had to be managed by an endothelial transplant covering the dehisced graft-host junction. In the third patient, hydrops secondary to trauma was also associated with acute haemops. Progression of keratoconus post keratoplasty can occur exclusively in the recipient bed leading to acute hydrops in the host sparing the transplanted cornea. The progressive thinning and ectasia of the recipient bed can also result in internal graft-host dehiscence leading to chronic oedema. Rapid entry of aqueous or blood cells into the corneal stroma following acute rupture of the Descemet's membrane suggests that the abnormal stroma of the eye with keratoconus may have an important role to play in the pathogenesis of acute hydrops/haemops.International Ophthalmology 11/2013; DOI:10.1007/s10792-013-9881-9 · 0.55 Impact Factor
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ABSTRACT: : Acute corneal hydrops (ACH) and perforation in corneal thinning diseases are the consequences of exposure to distending intraocular pressure (IOP) forces that are in excess of corneal resistance to them. Apart from thinning, resistance to these forces may be reduced by disease-related tissue changes, such as corneal scarring, which could lower resistance to IOP. Eye rubbing trauma has sometimes been found to be associated with ACH and perforation. This association is not surprising given that the combination of rubbing-related mechanical tissue trauma and the associated increased distending stress of higher IOP seem likely to increase the risk of complications. Many cases of ACH and perforation are described as spontaneous, but this classification may be the consequence of not considering the multiple potential mechanisms for IOP elevation such as coughing, sneezing, nose blowing, and sneeze suppression in addition to those related to eye rubbing/wiping/massaging/touching as well as changes in body orientation, strenuous exercise, and wearing swimming goggles for example. Classification of ACH or perforation as spontaneous may lead patients to assume that nothing can be done to avoid these complications. Patients with corneal thinning diseases who are counseled regarding the potential precipitating mechanisms for IOP elevation will have the opportunity of reducing exposure to them and the risk of the associated complications. In addition, when ACH or perforation occur, faster resolution of edema and wound healing may depend on reducing potentially exacerbating exposures to mechanisms for IOP elevation.Eye & Contact Lens Science & Clinical Practice 07/2014; 40(4):257-64. DOI:10.1097/ICL.0000000000000048 · 1.68 Impact Factor
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ABSTRACT: PurposeTo report a young child with bilateral keratoconus in the context of vernal keratoconjunctivitis (VKC) who developed bilateral corneal hydrops associated with eye rubbing, and to discuss the pathogenesis and review the pertinent literature.Case ReportA seven-year-old girl with VKC and asymmetric keratoconus developed corneal hydrops due to habitual eye rubbing. Corneal edema subsided within 16 weeks in her right eye and 9 weeks in the left eye with subsequent corneal scarring.ConclusionContinuous mechanical trauma, such as eye rubbing, plays a significant role in the pathogenesis of keratoconus and subsequent hydrops even in childhood.Journal of Ophthalmic & Vision Research 01/2014; 9(1):101-5.