Posters

Acute corneal hydrops secondary to keratoconus managed with thin-manual Descemet's stripping endothelial keratoplasty (TM-DSEK)

Poster Details

First Author: A. Tourkmani UNITED KINGDOM

Co Author(s):    A. Turnbull   R. Borbara   A. Konstantopoulos   P. Hossain   D. Anderson        

Abstract Details

Purpose:

To report the utility of Thin-Manual Descemet stripping endothelial keratoplasty (TM-DSEK) in the management of acute, severe corneal hydrops secondary to keratoconus.

Setting:

Corneal Service, Department of Ophthalmology, University Hospital Southampton, UK.

Methods:

A 15-year-old boy with known keratoconus presented with reduced vision and discomfort in the left eye, having been stable for 18 months previously. A diagnosis of acute, severe corneal hydrops was made and managed initially with topical dexamethasone and cyclopentolate. There was no response to medical treatment after six weeks. Two months after presentation, reduction of the hydrops combined with TM-DSEK was performed to help seal the area of ruptured Descemet's membrane (DM), expedite resolution and reduce the extent of post-hydrops scarring.

Results:

Other than a partial graft dislocation, the patient made an uneventful recovery postoperatively. Stromal oedema resolved over a period of weeks and the patient’s visual acuity improved towards baseline, faster than would have been expected without intervention. The patient remains under regular review and detailed outcomes with serial pachymetry and OCT images will be presented.

Conclusions:

Acute hydrops secondary to keratoconus can cause permanent stromal scarring necessitating deep anterior lamellar or penetrating keratoplasty. Central DM ruptures may extend peripherally, requiring a higher risk, large-diameter graft. Methods described to manage acute hydrops include gas tamponade and suturing, but results vary. Acute hydrops secondary to keratoglobus, as well as corneal decompensation due to DM rupture caused by obstetric forceps injury, have been successfully managed with endothelial keratoplasty previously. DSEK replaces ruptured DM and endothelium with healthy tissue, promoting rapid stromal deturgescence and minimising stromal scarring. This may expedite visual rehabilitation and avert the need for subsequent penetrating keratoplasty.

Financial Disclosure:

NONE