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A. Zavala-Ayala, N. Pereyra-Munoz, A. Martínez-Afanador, G. Ortiz-Nieva, R. Suárez-Sánchez; Spontaneous Hydrops Perforation: Case Report. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4320.
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The objective of presenting this case report is to emphasize on the extremely rare possibility of spontaneous hydrops perforation. Up until now, there are only 10 reports in the indexed medical literature of perforations secondary to corneal ectasias.
We report the case of a 30 year old female, from the state of Chiapas, Mexico, who presented to the Ophthalmology Institute "Conde de Valenciana", with a two month history of a leucoma in her left eye. The patient also suffered from Down Syndrome with profound mental retardation, and was therefore under constant observation by a relative or a nurse.
A complete ophthalmologic examination was performed. Visual acuity of OD was taking medium sized objects and the visual acuity of OS was worse than taking medium sized objects but not measurable because of the patients limited understanding of instructions. Intraocular pressure (measured under general anesthesia with a Tonopen tonometer) was 12 mmHg in OD and 14mmHg in OS. Biomicroscopy of OD showed Vogt striae and inferior corneal thinning. Biomicroscopy of OS showed a hydrops, with an inferior paracentral perforation sealed by iris and a flat anterior chamber; the remainder of the anterior segment and posterior segment structures were not vissible. Funduscopy of the OD was unremarkable. Echography of OS evidenced a normal posterior segment. After careful ethical consideration, the patient underwent tectonic penetrating keratoplasty of the OS.
This is the second case report of a spontaneously perforated corneal ectasia in a patient with Down Syndrome. Although there are only ten case reports of spontaneous corneal perforations in the medical literature, it is highly important to keep this possible complication of hydrops in mind.
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