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Browsing Medical Sciences - Publications by Subject "acute corneal hydrops"
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    Anterior segment optical coherence tomography features of acute corneal hydrops
    ( 2012-05-01) Basu, Sayan ; Vaddavalli, Pravin K. ; Vemuganti, Geeta K. ; Hasnat Ali, Md ; Murthy, Somasheila I.
    Purpose:: To describe the clinical significance of in vivo corneal findings in eyes with acute corneal hydrops. Methods:: Medical records and anterior segment optical coherence tomography (ASOCT) images of 24 patients with keratoconus and unilateral acute corneal hydrops were reviewed. Clinical findings and position, integrity, and orientation of the Descemet membrane (DM) on ASOCT were noted. Size of the DM break, depth of the DM detachment, and corneal thickness were measured by ASOCT and correlated with the duration of corneal edema, assessed clinically. Outcomes of intracameral perfluoropropane (C3F8) gas in 13 eyes and histopathological findings after penetrating keratoplasty in 2 eyes were also correlated with serial ASOCT findings. Results:: Duration of corneal edema was 9.3 ± 4.4 weeks. On ASOCT, DM showed 3 patterns: detachment with break and rolled ends (n=13), detachment with break and flat ends (n=10), and detachment with no break (n=1). Initial corneal thickness was 1.3 ± 0.25 mm, size of the DM break was 1.1 ± 0.8 mm, and depth of the DM detachment was 0.9 ± 0.6 mm. On multiple regression analysis, duration of corneal edema showed significant positive association with the depth of DM detachment (P=0.0002) and size of DM break (P=0.002) and negative association with intracameral C3F8 (P < 0.0001). Correlation of ASOCT with histopathological findings revealed 2 stages of resolution of hydrops: reattachment of DM and endothelial migration. Conclusions:: Eyes with deeper DM detachments and larger DM breaks required more time for resolution of corneal edema despite intracameral C3F8. This association needs to be validated by a prospective study. © 2012 by Lippincott Williams & Wilkins.
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    Long-term outcomes of penetrating keratoplasty for keratoconus with resolved corneal hydrops
    ( 2012-06-01) Basu, Sayan ; Reddy, Jagadesh C. ; Vaddavalli, Pravin K. ; Vemuganti, Geeta K. ; Sangwan, Virender S.
    Purpose: To address the controversial issue of whether the occurrence of corneal hydrops adversely affects the fate of subsequent penetrating keratoplasty (PK), this study compared the long-term outcomes of PK in keratoconic eyes with resolved corneal hydrops with those without prior corneal hydrops. Methods: This was a retrospective chart review of 102 eyes of 102 patients with keratoconus who underwent PK. The primary outcome measure was endothelial rejection-free allograft survival and the secondary outcomes were vision, postoperative complications, and histopathologic findings of corneal buttons obtained during PK. Results: The mean follow-up after PK was 5.5 ± 3.3 years. The Kaplan-Meier endothelial rejection-free allograft survival at 1 and 5 years post-PK were 93.7% ± 4% and 82.6% ± 7%, respectively, in 32 eyes with hydrops and 100% and 98% ± 2%, respectively, in 70 eyes without hydrops (P = 0.04). Multivariate analysis showed that the risk of endothelial rejection episodes was greater in eyes with longer duration of corneal hydrops (P = 0.019) and coexistent ocular allergy (P = 0.012). All rejection episodes were reversed medically and only 1 allograft failed because of postoperative endophthalmitis. More than 90% of eyes achieved a visual acuity of better than 20/40. Common postoperative complications were cataract and graft infiltrate. Histopathology in cases of resolved hydrops after intracameral gas showed unique compression artifacts like folding and burial of the broken ends of Descemet membrane in the stroma. Conclusions: 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. Copyright © 2012 by Lippincott Williams & Wilkins.