Área Técnica: Córnea
ANTERIOR SEGMENT OPTICAL COEHERENCE IN ACUTE CORNEAL HYDROPS
Report a case of acute hydrops episode during follow-up of a patient with keratoconus and the use of Anterior Segment Optical Coherence Tomography (AS-OCT) to investigate the ultrastructural changes in the cornea.
We described a 23 year-old man with brown skin diagnosed with keratoconus. He was admitted at Porto Alegre Eye Bank Hospital referring blurred vision and pain in the right eye. His best corrected visual acuity with spectacles was logMAR 1.3 (20/400) OR and logMAR 0.5 (20/60) OS. He was diagnosed with an episode of acute hydrops through the clinical examination. Important corneal edema was observed in the slit lamp examination. AS-OCT revealed stromal edema with ruptured Descemet membrane.
Acute hydrops in corneal ectatic disease is an incompletely understood complication and visually debilitating condition associated with significant morbidity in an otherwise healthy young population. Associated risk factors include eye rubbing, vernal keratoconjunctivitis, atopy and Down’s syndrome. Surgical intervention includes intracameral injection of air/gas and, in special situations, compressive sutures, penetrating keratoplasty, cyanoacrylate adhesive with bandage contact lens and amniotic membrane transplantation with cauterization. Conservative treatment includes observation, topical lubrication, pressure patching, bandage contact lens, topical hypertonic saline, topical corticosteroids, cycloplegic and anti‑glaucoma medications. No significant difference in terms of final best-corrected visual acuity was observed. The resolution of corneal edema may occur any time between 5 and 36 week. The resolution is due to the spontaneous apposition of the broken ends of Descemet membrane to the corneal stroma and endothelial redistribution over the area left devoid of Descemet membrane. Our case presented with detachment with break and flat ends. Determining, with AS-OCT, the size and extent of edema and Descemet membrane tear may help in formulating the treatment plan, monitoring it response and identifying any complication.