Clinical features and keratoplasty results in keratoconus complicated by acute hydrops

Purpose: Acute hydrops develops when Descemet's membrane and the endotheliu m of the ectatic cornea separates to allow aqueous humor to enter the strom a. The current study was done to determine if penetrating keratoplasty (PK) in keratoconus patients with resolved hydrops has a poor prognosis. Method s: A retrospective chart review of 35 eyes of 35 patients with keratoconus who underwent PK after the resolution of acute hydrops (Group 1) and of 74 eyes of 69 patients who had PK without a previous history of acute hydrops (Group 2) was performed. The chi-square test was used for statistical analy sis. Results: The mean age in Group 1 was 21.1 +/- 11.0 years. The mean age in Group 2 was 23.2 +/- 14.4 years. Vernal keratoconjunctivitis was presen t in 11 patients in Group 1 (31%) and in 12 (17.4%) patients in Group 2. Lo ose sutures were present in two patients (6%) in Group 1; both resulted in loose suture-related corneal neovascularization. Loose sutures developed in five patients (7%) in Group 2. In Group 1, three patients (9%) had microbi al keratitis. Microbial keratitis was seen in five patients (7%) in Group 2 . Two patients (6%) in Group 1 developed late endothelial graft failure. In Group 2, one eye (1%) developed early and one eye (1%) late epithelial gra ft rejection; five eyes (7%) developed late endothelial graft rejection. Th ere was no statistically significant difference between the two groups with respect to the incidence of graft rejection. At the last examination, 34 e yes in Group 1 had clear grafts; in the second group, graft clarity was ach ieved in 71 eyes. Conclusion: Penetrating keratoplasty in hydrops is succes sful in terms of graft clarity and visual outcome in patients with keratoco nus after the resolution of hydrops. The patients should have preoperative and postoperative anti-allergic treatment and close follow-up for possible complications.