ACUTE CORNEAL HYDROPS IN KERATOCONUS

Purpose: To determine the clinical factors associated with the develop ment of acute corneal hydrops and its subsequent outcome. Methods: The authors identified 147 eyes (124 patients) with acute hydrops from a database of 5242 eyes (2723 patients) with keratoconus. They compared the clinical features of patients in whom hydrops developed with unaff ected patients and assessed the progression to penetrating keratoplast y by actuarial methods. Results: Patients in whom acute hydrops develo ped tended to be younger males who had advanced corneal ectasia and a poor corrected Snellen visual acuity at the diagnosis of their keratoc onus (P < 0.001). Acute hydrops also was more common in the presence o f severe allergic eye disease (P < 0.001). The development of hydrops was a very significant risk factor for subsequently receiving a penetr ating keratoplasty (P < 0.00001) and at the end of the study period 87 (59%) of the 147 eyes had surgery for visual rehabilitation. These ey es had a greater rate of graft rejection than eyes grafted without hyd rops (P = 0.02). After resolution of the hydrops, 46 of the 60 unopera ted eyes had been refitted with contact lenses, of which 28 (61%) achi eved a Snellen visual acuity of 20/40 or better, although a better vis ual acuity often was present in the contralateral eye. Microbial kerat itis developed in two of these eyes after refitting. Conclusions: Alth ough a penetrating keratoplasty often is indicated for visual rehabili tation after acute corneal hydrops, there is an increased rate of reje ction. Only a minority of eyes were re-established in contact lenses a fter resolution of hydrops, but some patients achieved a functional le vel of visual acuity such that the procedure could be delayed or avoid ed.