%0 Journal Article
%T Descemet Stripping Endothelial Keratoplasty in a Patient with Keratoglobus and Chronic Hydrops Secondary to a Spontaneous Descemet Membrane Tear
%A Anton M. Kolomeyer
%A David S. Chu
%J Case Reports in Ophthalmological Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/697403
%X Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient with keratoglobus and chronic hydrops. Case Report. We describe a case of a 28-year-old man with bilateral keratoglobus and chronic hydrops in the right eye secondary to spontaneous Descemet membrane tear. The patient presented with finger counting (CF) vision, itching, foreign body sensation, and severe photophobia in the right eye. Peripheral corneal thinning with central corneal protrusion and Descemet membrane tear spanning from 4 to 7 o'clock was noted on slit lamp examination. The right eye cornea was 15£żmm in the horizontal diameter. After a 5.5-month loss to follow-up, the patient presented with discomfort, photophobia, decreasing vision, and tearing in the right eye. Vision was 20/60 with pinhole. 360-degree peripheral corneal ectasia with mild neovascularization and hydrops was present. Over the next few months, the patient complained of photophobia and intermittent eye pain. His vision deteriorated to CF, he developed corneal scarring with bullae, and a DSEK was performed. Eight months postoperatively, best-corrected vision improved to 20/30, cornea was clear, and the DSEK graft was stable. Conclusions. Nonresolving hydrops secondary to Descemet membrane tear in a patient with keratoglobus may result in permanent endothelial cell damage and scar formation. This may be successfully treated with DSEK. 1. Introduction Keratoglobus is an idiopathic disorder with 360-degree peripheral corneal ectasia resulting in central corneal protrusion [1]. It is associated with ocular conditions such as orbital pseudotumor, vernal keratoconjunctivitis, chronic marginal blepharitis, and glaucoma after penetrating keratoplasty surgery; congenital conditions including Leber congenital amaurosis and blue sclera syndrome; and several connective tissue disorders, for example, Ehlers-Danlos syndrome, Marfan syndrome, and Rubinstein-Taybi syndrome [2¨C6]. Visual impairment in patients with keratoglobus can be profound, and may occur secondarily to corneal scarring and rupture (due to severe corneal ectasia), irregular astigmatism, and extreme myopia. Hydrops develops due to breaks in the Descemet membrane followed by aqueous infiltration of the stroma and the epithelium in up to 91% of keratoglobus eyes, and can result in corneal scar formation in severe cases [7]. Other reported serious side effects include corneal perforation, microbial keratitis, and glaucoma [8, 9]. Factors predisposing to the development of hydrops include younger age, male gender, advanced corneal
%U http://www.hindawi.com/journals/criopm/2013/697403/