HYDROPS: ABOUT 4 CASES

Hydrops or acute keratoconus is a common complication that can occur spontaneously or after trauma in patients with keratoconus.
It is characterized by significant bullous edema of the cornea secondary to breaks in the Descemet membrane and an influx of aqueous into the stroma and epithelium of the corneawhich is the cause of all symptoms. The diagnosis is easy but the treatment is long and the visual prognosis is guarded.

ophtalmology B departement ibn sina university hospital

We present 4 cases of acute keratoconus, 2 children aged 12 and 16 years and 2 adult sisters aged 19 and 21 years. Although all patients experienced a noticeable decrease in visual acuity, they were unaware of having keratoconus. Upon investigation, we identified a history of ocular allergy in all patients but no evidence of trauma. The damage was unilateral in all patients.
visual acuity decreased with hand movement on admission. Examination of the anterior segment revealed significant stromal oedema with increased corneal thickness, subepithelial bullae and corneal striae. No changes were observed in the fundus. The adelphic eye exhibited keratoconus but no signs of hydrops. Local and oral hypotensives, local mast cell antidegranulants, artificial tears and occlusion were provided to all patients, particularly during severe photophobia. The course of treatment lasted several weeks and was marked by a regression of the oedema.

Keratoconus is observed in cases of impaired corneal biochemical activity, leading to secondary thinning and ectasia. Usually the onset is in the second – third decade of life. The acute corneal hydrops occurs when intraocular aqueous passes through a rupture of Descemet membrane (DM) and is characterized with stromal edema. Estimated frequency is 2.5 – 3.0% among the keratoconus patient. Eye rubbing is the major risk factor. In most cases the hydrops persists for 2 -4 months. The resolution is cicatrix/scar formation, but there is a risk for complications such as vascularization, infection and corneal perforation.

The treatment could be conservative or surgical. The conservative therapy includes topical lubricants, antibiotics, cycloplegics, hyperosmotic solutions, antiglaucoma drugs, topical corticosteroids and nonsteroid anti-inflammatory drugs. Surgical treatment includes intracameral injection of air or gas, but the definitive treatment is penetrating keratoplasty.

acute keratoconus onset accelerates the evolution of the condition, as corneal opacities in the axial region indicate the necessity for corneal transplantation. Unfortunately, corneal transplantation remains challenging to access in our country due to lack of donation and inadequate resources.