Persisting extreme acute corneal hydrops with a giant intrastromal cleft secondary to keratoconus

Gokul, Akilesh; Krishnan, Thiyaga; Emanuel, Patrick O.; Saunders, Mark; McGhee, Charles N J

doi:10.1111/cxo.12260

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…It has been reported that the average thickness of the keratoconic cornea is reduced to approximately 437μm centrally and 559μm towards the periphery, 17 whereas, in cases with unresolved oedema following Descemet's membrane rupture, the central cornea can be 878μm 18 or more. 19 However, our subject with keratoconus and resolved oedema provided much thinner corneal measurements at 260μm centrally and 450μm at 8mm diameter. This extreme thinning and flattening of the central cornea might be a result of the extensive rupture of Descemet's membrane.…”

Section: Discussionmentioning

confidence: 66%

Extreme Descemet's membrane rupture with hydrops in keratoconus: Clinical and histological manifestations

Loh

Gaskin

Sherwin

et al. 2018

American Journal of Ophthalmology Case Reports

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PurposeTo study the clinical and histological manifestations of an extreme Descemet's membrane rupture as a result of keratoconus.ObservationsUsing Periodic acid-Schiff assay to study a keratoconic cornea with an extreme rupture showed that the ruptured Descemet's membrane had retracted and folded into scrolls and ridges. The dimensions of the rupture were estimated to be 3.7mm2, and the central cornea was extremely thinned with a thickness of only 260μm. Stromal scarring and loosely packed lamellae were present anterior to the scrolls and ridges. Antibodies targetting the major components of Descemet's membrane, Laminin and type IV collagen, displayed intense labelling adjacent to the scrolls where the stroma was denuded and differential expression patterns lined the ridges. Environmental scanning electron microscopy showed possible collagen deposition at the site of rupture.Conclusions and importanceThe specific staining patterns of laminin and type IV collagen suggest these components have an important role in re-endothelisation of the cornea. This is the first known report of spatial resolution of the topography of the Descemet's membrane rupture established by environmental scanning electron microscopic image montage.

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Section: Discussionmentioning

confidence: 66%

Extreme Descemet's membrane rupture with hydrops in keratoconus: Clinical and histological manifestations

Loh

Gaskin

Sherwin

et al. 2018

American Journal of Ophthalmology Case Reports

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“…ACH is a severe complication of keratoconus, caused by disruption and local detachment of the DM ( 5 , 6 ). Due to its elasticity, DM retracts or coils when it breaks under tension, and the aqueous humor flows into the corneal stroma, causing severe corneal edema and opacity, and even leading to the formation of intrastromal clefts (pseudocysts).…”

Section: Discussionmentioning

confidence: 99%

“…Keratoconus is a chronic ectatic corneal disorder whose etiology, which seems to involve the inflammatory cascade, and is related to mechanical trauma from the habit of rubbing the eyes and nocturnal ocular compression ( 1 , 2 ), is still the subject of extensive debate, is characterized by the presence of irregular astigmatism and corneal thinning, which usually progress during the first three decades of life ( 3 , 4 ). Acute corneal hydrops (ACH), which may result in corneal scars and vision loss, is an uncommon complication of keratoconus secondary to rapid stromal edema, and even intrastromal clefts (pseudocysts) formation, secondary to Descemet membrane rupture ( 5 , 6 ). ACH is usually self-limiting and generally resolves without intervention over 2–4 months ( 7 ), and may preset complications such as neovascularization ( 8 ), infection, malignant glaucoma, and corneal perforation ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

Deep anterior lamellar keratoplasty following thermokeratoplasty assisted epikeratophkia: A novel two-stage one-graft method to treat acute corneal hydrops

et al. 2023

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PurposeTo evaluate the clinical effects of deep anterior lamellar keratoplasty (DALK) using a single graft after thermokeratoplasty assisted epikeratophakia for the treatment of acute corneal hydrops.MethodsThis novel surgical procedure was performed on seven eyes of seven patients between 2019 and 2020. The procedure combines a first-stage surgery of thermokeratoplasty assisted epikeratophkia with intracameral sterile air injection and a second-stage surgery of DALK using the same corneal graft for both procedures. Main outcome measures included pre- and postoperative corrected distance visual acuity (CDVA) and anterior segment optical coherence tomography (AS-OCT) parameters. Corneal transparency, epithelization, and the presence of neovascularization, were evaluated at the 1-year follow-up visit.ResultsCorneal edema resolved rapidly in six of the seven cases. The mean central corneal thickness was significantly reduced from baseline to 1 day, 1 week, 1 month, and 2 months after the first-stage surgery (P < 0.0001). At a mean of 2.1 ± 0.7 months after the first-stage surgery, DALK was successfully performed in all cases. Six months later, the mean central corneal thickness was 611 ± 31 μm and the mean thickness of the recipient’s residual stroma bed was 20 ± 6 μm at the central corneal area. Mean LogMAR CDVA improved from 1.74 ± 0.34 at baseline to 0.20 ± 0.11 after DALK (P < 0.0001). No postoperative complications appeared in our case series during the 1-year observation period.ConclusionVery good visual results were obtained with a novel technique (thermokeratoplasty assisted epikeratophakia followed by DALK using the same corneal graft) in the treatment of acute corneal hydrops.

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“…Die Wundheilung mit Ausbildung einer neuen Descemet-Membran durch migrierendes Endothel ( Abb. 2 c ) erfolgt über mehrere Wochen und kann mittels Muraine-Nähten unterstützt werden 18 . Die Neubildung der Descemet-Membran nach akutem Keratokonus mit den charakteristischerweise eingerollten Rändern im Rissbereich und einer dünnen „neuen“ Descemet-Membran findet sich sowohl bei Spontanheilung als auch nach Muraine-Nähten.…”

Section: Keratektasienunclassified

“…Wound healing with formation of a new Descemet membrane through endothelial migration ( Fig. 2 c ) takes several weeks and can be supported by Muraine sutures 18 . Reformation of the Descemet membrane after acute keratoconus, with characteristically rolled-up edges in the area of the tear and a thin “new” Descemet membrane, is observed both with spontaneous healing and after application of Muraine sutures.…”

Section: Corneal Ectasiamentioning

confidence: 99%

Histopathologische Veränderungen bei kornealen Ektasien

Bulirsch

Löffler

Holz

et al. 2023

Klin Monbl Augenheilkd

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Den kornealen Ektasien werden der Keratokonus, der Keratoglobus, die pelluzide marginale Degeneration sowie iatrogene Keratektasien zugeordnet. Bei allen Formen der kornealen Ektasie kommt es zu einer Verdünnung der Hornhaut, die mit einer kornealen Aufsteilung sowie einem irregulären Astigmatismus einhergeht. Nachfolgend wird ein Überblick über histopathologische Veränderungen der verschiedenen kornealen Ektasien gegeben. Ebenso werden histologische Veränderungen nach operativen Verfahren, die im Zusammenhang mit Ektasien durchgeführt werden, wie das korneale Crosslinking und die perforierende Keratoplastik (pKPL) sowie nach refraktiven chirurgischen Verfahren, die potenziell zu einer Ektasie führen können, dargestellt. Neben einer Literaturrecherche erfolgte auch die Aufarbeitung und Untersuchung von histopathologischem Archivmaterial zur exemplarischen Darstellung der spezifischen histologischen Veränderungen. Corneal ectasia comprises keratoconus, keratoglobus, pellucid marginal degeneration, and iatrogenic keratectasia. In all forms of corneal ectasia, there is a thinning of the cornea, usually accompanied by steepening of the cornea, leading to irregular astigmatism. Here we provide an overview of histopathologic alterations of the various corneal ectasias. Furthermore, histologic changes after surgical procedures which are performed in severe cases of corneal ectasia such as corneal crosslinking and penetrating keratoplasty (pKPL) as well as refractive surgical procedures which may lead to postsurgical ectasia are presented. In addition to a literature review, histopathologic archival material was reviewed and examined to illustrate the specific histologic changes.

show abstract

Persisting extreme acute corneal hydrops with a giant intrastromal cleft secondary to keratoconus

Abstract: Acute corneal hydrops (hydrops corneae) is an incompletely understood complication of keratoconus and other corneal ectatic disorders, including keratoglobus and pellucid marginal corneal degeneration.

Cited by 6 publications

References 12 publications

Extreme Descemet's membrane rupture with hydrops in keratoconus: Clinical and histological manifestations

Extreme Descemet's membrane rupture with hydrops in keratoconus: Clinical and histological manifestations

Deep anterior lamellar keratoplasty following thermokeratoplasty assisted epikeratophkia: A novel two-stage one-graft method to treat acute corneal hydrops

Histopathologische Veränderungen bei kornealen Ektasien

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