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John B. Cason, Samuel Yiu; Acute Hydrops in the Donor Cornea Graft of Non-keratoconus Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):358.
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To report three patients with hydrops in the donor cornea graft without a history of keratoconus.
A retrospective case-series report.
Patient 1. A 44-year-old HIV positive Hispanic male presented to the clinic with a five-week history of decreased vision one year after PKP left eye. He had hand-motion vision in the left eye uncorrected. The intraocular pressure was not measurable. He had a very edematous, opaque, protuberant cornea graft. He had a well-covered glaucoma drainage valve in the superotemporal quadrant. Anterior segment ocular coherence tomography (OCT) showed a deep stroma cystic cavity consistent with hydrops in the left eye. Anterior segment ultrasound biomicroscopy (UBM) showed a Descemet’s detachment and severe cornea edema with stroma cystic cavities. The patient received a repeat PKP OS. Pathology examination revealed a rupture and recoil of Descemet’s membrane centrally and near perforation with remarkable cornea stroma edema consistent with hydrops. Patient 2. A 91-year-old Caucasian male with history of PKP x 2 was referred to the clinic for "descemetocele" evaluation. On examination he had light perception with projection vision in the right eye. Intraocular pressure was not measurable. He had a very large pedunculated cyst within the cornea graft. Anterior segment OCT revealed a deep stroma cystic cavity consistent with hydrops. Anterior segment UBM showed a large cystic cavity with suspected break in Descemet's membrane. The patient subsequently received a repeat PKP in the right eye. Pathology examination revealed marked cornea edema consistent with hydrops. There was absent Descemet’s membrane except for fragments on both sides of the button.Patient 3. A 98-year-old female with a history of PKP OD 5 years prior presented with decreasing vision for several months. She reported rubbing her eyes. Her vision was 20/CF 1 foot OD and IOP was 18 mm Hg. She had a large cyst in the inferior donor cornea near the host rim which was consisted with hydrops. She had a posterior chamber IOL. The patient declined surgical intervention.
To the authors’ knowledge this is the first report of patients without a history of keratoconus who developed hydrops.1,2 An anterior chamber intraocular lens and a glaucoma drainage tube were suspected to have been the culprit in two patients. Cornea transplant patients should be advised not to rub their eyes.
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