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Case Report: Acute Hydrops with Descemet Membrane Schisis in Corneal Ectasia after Radial Keratotomy

Xie, Wenjia, MD, OD; Xu, Yesheng, MD, PhD; Yao, Yu-Feng, MD, PhD*

doi: 10.1097/OPX.0000000000001163

SIGNIFICANCE As patients with previous radial keratotomy (RK) are still occasionally encountered, recognition of the anatomy of post-RK corneas and management of their complications remain relevant. High-definition anterior segment optical coherence tomography (AS-OCT) is a very useful tool to assess these postsurgical corneas.

PURPOSE To describe a case of acute corneal hydrops with Descemet membrane schisis after RK with observation by AS-OCT.

CASE REPORT A 43-year-old woman presented with a 9-day history of sudden vision loss, foreign body sensation, and photophobia in her left eye. She had undergone bilateral RK 25 years ago at her local hospital. Slit-lamp examination revealed marked corneal edema and stromal clefts in the central cornea along with radial surgical scars in her left eye. Pentacam imaging showed the typical pattern of a post-RK cornea with ectasia in her right eye. Multiple dilacerations of collagen lamellae and fluid-filled intrastromal cysts together with epithelial edema were observed in her left eye using AS-OCT. A Descemet membrane detachment with schisis was also shown by AS-OCT. After 5 months of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment once daily, the corneal edema, Descemet membrane detachment, and Descemet membrane schisis had completely resolved resulting in pan-stromal scarring.

CONCLUSIONS This report describes acute corneal hydrops with Descemet membrane schisis after RK imaged using high-definition AS-OCT. The acute hydrops was possibly caused by corneal ectasia or underlying keratoconus, which was aggravated by RK. High-definition AS-OCT is a useful tool to demonstrate the details of different corneal layers and to observe the resolving process of acute hydrops. Topical medications consisting of antibiotic, lubrication, and corticosteroid can be used to treat the acute event effectively.

Department of Ophthalmology Sir Run Run Shaw Hospital Zhejiang University School of Medicine Hangzhou, China (all authors) *

Submitted: March 24, 2017

Accepted: September 17, 2017

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions: Methodology: WX; Writing – Original Draft: WX, YX; Writing – Review & Editing; WX, YX, YFY; Conceptualization: YFY; Methodology: YFY; Supervision: YFY.

© 2018 American Academy of Optometry