Acute corneal hydrops 3 years after Intra-corneal ring segments and corneal collagen Cross-linking

Abstract

This case report describes a 15-year-old male with allergic conjunctivitis and keratoconus, who underwent uneventful intra-corneal ring segment (ICRS) implantation and corneal collagen cross-linking (CXL) in the right eye. During the follow-up periods, the patient was noted to have several episodes of allergic conjunctivitis that were treated accordingly. At the 2 years postoperatively, he presented with another episode of allergic conjunctivitis and progression of keratoconus was suspected on topography. However, the patient was lost to follow-up, until he presented with acute hydrops at 3 years postoperatively. There are no reported cases of acute corneal hydrops in cross-linked corneas. We suspect the young age, allergic conjunctivitis and eye rubbing may be a risk factors associated with possible progression of keratoconus after CXL. Prolonged follow-up and aggressive control of the allergy might be necessary in similar cases.

Case Report: Acute Corneal Hydrops despite Accelerated Transepithelial Corneal Cross-linking

“…The development of corneal hydrops despite previous cross-linking has been reported after traditional epithelium-off treatment in two patients whom we could identify 9,10 . There is also a report of one case of mild corneal hydrops after accelerated, transepithelial cross-linking using the same protocol that we describe in this report and that also occurred at 3.5 years after the procedure 11 .…”

“…The development of corneal hydrops despite previous crosslinking has been reported after traditional epithelium-off treatment in two patients whom we could identify. 9,10 There is also a report of one case of mild corneal hydrops after accelerated, transepithelial cross-linking using the same protocol that we describe in this report and that also occurred at 3.5 years after the procedure. 11 The major differences between our case and the previously reported case are that the previous case did not experience significant corneal flattening after the procedure, and a more shallow demarcation line was measured on ocular coherence tomography (153 μm), suggesting a more superficial treatment in that case.…”

Long-Term Outcomes of Bowman Layer Inlay Transplantation for the Treatment of Progressive Keratoconus

“…26 It has been hypothesized that stimulation of anterior stromal cell apoptosis due to eye rubbing results in secondary increase of inflammatory mediators, which potentially induce further progression and subsequent occurrence of hydrops. 26 Therefore, a more aggressive control of hypersensitivity triggers, preventing continuation of eye rubbing and arresting allergy, seems advisable for KC eyes in general, also after treatment. 27,28 It should be noted that although the total cohort in this current long-term study is larger than in the previously reported BL inlay studies, the relatively small sample size of group 2 may have limited the power of our statistical analyses and comparison between the groups.…”

Corneal Hydrops Secondary to Intrastromal Corneal Ring Intrusion into the Anterior Chamber 7 Years after Implantation: A Case Report

“…Corneal edema within 1 week of INTACS implantation has been reported and hypothesized to be related to the induction of endothelial dysfunction by the femtosecond laser used to create the INTACS stromal tunnel [ 5 , 6 ]. Antonios et al report the only instance of significantly delayed corneal hydrops or edema with the concurrent presence of an INTACS device was in a patient with severe recurring allergic keratoconjunctivitis and keratoconus who underwent CXL and INTACS implantation 3 years prior [ 7 ]. There was no evidence of INTACS migration or corneal perforation, and the presence of the INTACS ring appears coincidental rather than causal.…”