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First Author: A.Herceg SLOVENIA
Co Author(s): M. Stabuc Silih
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Follow-up report of three cases of severe, acute, unilateral hydrops in patients with bilateral keratoconus and congenital conditions.
Keratoconus is a bilateral, non-inflammatory and progressive corneal ectasia with an incidence of 1 per 2000. It is diagnosed more often in people with Down syndrome. Acute hydrops is an influx of aqueous into the cornea as a result of a rupture in Descemet"s membrane. It can cause a sudden decrease in vision, pain, red eye, photophobia and profuse tearing. It occurs in 3% of patients with keratoconus. Therapy of hydrops is conservative.
22 year-old woman with congenital deformation of lacrimal canaliculus, 39 year-old woman with Down syndrome and 32 year-old man with mental retardation, all presented with sudden decrease of visual acuity, redness, pain, burning sensation and increased tearing. Slit-lamp examination revealed conjunctival hyperemia, very extensive corneal oedema, and in two cases large fluid-filled intrastromal clefts.
With conservative therapy corneal oedema in all cases took a few months to resolve, and left a residual smaller or bigger scar. Some authors report the usage of intracameral gas injections, that significantly reduce healing period, however the issue of complications needs to be explored in a more extensive study with longer follow-up.
With accurate and prompt clinical diagnosis hospitalisation of patients with acute hydrops is unnecessary, as it doesn"t shorten the healing period or affect the functional outcome. Close observation allows for the early detection and treatment of complications such as perforation and infection. Acute hydrops is not an indication for emergency corneal transplantation, except in rare cases of corneal perforation, which may be first treated with tissue adhesives and bandage contact lenses.