Long-term Outcomes of Penetrating Keratoplasty for Keratoconus With Resolved Corneal Hydrops

Basu, Sayan; Reddy, Jagadesh C; Vaddavalli, Pravin K.; Vemuganti, Geeta K.; Sangwan, Veena

doi:10.1097/ico.0b013e31823d03e3

Cited by 45 publications

(25 citation statements)

References 24 publications

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“…Most recently, it was found that keratoconic eyes with prolonged hydrops (ie, .3 months) and/or those with coexistent ocular allergy were more prone to postgraft endothelial rejection. 22 Neovascularization also compromises the physiologic corneal immune privilege, potentially doubling the risk of allograft rejection. [23][24][25] The presence of seasonal allergic conjunctivitis, protracted clinical course of the hydrops, and development of corneal neovascularization are therefore significant negative prognostic factors for the longevity of any transplant for this child.…”

Section: Discussionmentioning

confidence: 99%

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Downie

2014

Pediatrics

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Acute corneal hydrops is a rare complication of advanced corneal ectasia. This case report describes the clinical course of a child with severe atopy and no previous ocular examination who developed bilateral, acute corneal hydrops, secondary to keratoconus, by 8 years of age. The report demonstrates the rapidity of progression in the pediatric phenotype of the disease. This case also provides an important clinical lesson in highlighting the necessity for children with atopy to be referred for comprehensive ophthalmic examination, even in the apparent absence of visual symptoms, to ensure the timely diagnosis and management of any atopy-associated ocular disease. Prompt referral is particularly essential for pediatric corneal ectasia, in which the rapidity of progression may preclude stabilizing treatments, such as corneal collagen cross-linking, and result in significant childhood visual impairment, as was the case for this child. This case demonstrates the potential for significant ocular involvement in atopic children and identifies scope to enhance current international clinical guidelines relating to the management of childhood atopy through the inclusion of ocular screening for associated disease.

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Section: Discussionmentioning

confidence: 99%

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Downie

2014

Pediatrics

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“…Features of corneal hydrops seen on histopathology, and more recently using anterior segment optical coherence tomography, include epithelial and stromal edema, intrastromal fluid clefts, and changes in the DM (Figure 2). The DM can show detachment from the stroma with or without breaks and flat or rolled ends 54,55…”

Section: Pathologymentioning

confidence: 99%

Keratoconus: current perspectives

Vazirani

Basu²

2013

OPTH

Self Cite

106

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Keratoconus is characterized by progressive corneal protrusion and thinning, leading to irregular astigmatism and impairment in visual function. The etiology and pathogenesis of the condition are not fully understood. However, significant strides have been made in early clinical detection of the disease, as well as towards providing optimal optical and surgical correction for improving the quality of vision in affected patients. The past two decades, in particular, have seen exciting new developments promising to alter the natural history of keratoconus in a favorable way for the first time. This comprehensive review focuses on analyzing the role of advanced imaging techniques in the diagnosis and treatment of keratoconus and evaluating the evidence supporting or refuting the efficacy of therapeutic advances for keratoconus, such as newer contact lens designs, collagen crosslinking, deep anterior lamellar keratoplasty, intracorneal ring segments, photorefractive keratectomy, and phakic intraocular lenses.

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“…Severe complications of corneal hydrops are infrequent but include extensive corneal scarring, severe neovascularisation, epithelial defects, microbial keratitis, corneal perforation and glaucoma . A history of hydrops may also predispose subjects to greater likelihood of episodes of endothelial graft rejection after penetrating keratoplasty …”

mentioning

confidence: 99%

The Auckland keratoconus study: Identifying predictors of acute corneal hydrops in keratoconus

Gaskin

Good

Jordan

et al. 2013

Clinical and Experimental Optometry

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Background:The aim was to identify potential factors associated with acute corneal hydrops in a New Zealand population with keratoconus referred to a hospital eye service. Methods: In a single hospital centre, in a retrospective review, demographic and clinical features of subjects with keratoconus and corneal hydrops over a 17-year period were compared with an age-and gender-matched control group of subjects with keratoconus but no history of corneal hydrops. Results: One hundred and one eyes of 101 subjects (mean age 24.6 Ϯ 8.4 years) were identified with keratoconus-related corneal hydrops. Subjects were more likely to be of Pacific but less likely to be of New Zealand European ethnicity than control subjects (n = 101). In comparison, Maori ethnicity was not found to have a significantly positive or negative association with hydrops. The pre-hydrops visual acuity (VA) of affected eyes was poorer than that of controls (p < 0.001) at first presentation to our tertiary referral corneal and contact lens service. Hydrops typically developed approximately four years after diagnosis of keratoconus. Subjects with hydrops were more likely to have a history of eye-rubbing (p = 0.011) but less likely to have a family history of keratoconus (p = 0.05). In 31 cases, the acute hydrops event was their first optometric/ophthalmologic contact. There were no statistically significant differences in the prevalence of atopic disease, contact lens wear or overall corneal transplantation rate between the two groups. Conclusions: Pacific ethnicity, history of eye-rubbing, poor VA at first hospital presentation and lack of family history were statistically associated with developing acute corneal hydrops in keratoconus in a New Zealand population. Greater understanding of such predisposing risk factors may help develop early management strategies to delay or prevent progression of this disease.

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Long-term Outcomes of Penetrating Keratoplasty for Keratoconus With Resolved Corneal Hydrops

Abstract: Although endothelial rejection episodes are more common in eyes with resolved corneal hydrops, long-term allograft survival and visual results after PK in eyes with keratoconus are excellent, irrespective of prior corneal hydrops.

Cited by 45 publications

References 24 publications

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Keratoconus: current perspectives

The Auckland keratoconus study: Identifying predictors of acute corneal hydrops in keratoconus

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