Acute Hydrops in the Donor Cornea Graft in Non-Keratoconus Patients
A 44-year-old human immunodeficiency virus positive Hispanic male with undetectable viral load presented to the clinic with a 5-week history of decreased vision, 1 year after undergoing PKP in the left eye. The patient had a history of herpes keratitis complicated by severe glaucoma in that eye. He had received a corneal transplant 2 years before for corneal decompensation. On the day of presentation, his best-corrected vision was 20/20 in the right eye and hand-motion at 6 feet in the left eye. His manifest refraction in the right eye was −3.00 + 0.50 × 148. The intraocular pressure was 15 mm Hg in the right eye. His corneal graft was very edematous, opaque, and protuberant making it impossible to measure the intraocular pressure in the left eye. The glaucoma drainage valve in the superotemporal quadrant was well-covered. There was no evidence of keratoconus in the fellow eye. Ocular coherence tomography (OCT) of the anterior segment showed a deep stromal cystic cavity consistent with hydrops in the left eye []. Ultrasound biomicroscopy (UBM) of the anterior segment revealed a Descemet's membrane detachment and severe corneal edema with stromal cystic cavities []. The patient received a repeat PKP of the left eye. During surgery, the glaucoma drainage tube was noted to be positioned close to the cornea and was trimmed under the host cornea rim. Pathology examination revealed a rupture and recoil of Descemet's membrane centrally and a near perforation with a substantial amount of corneal stromal edema, consistent with hydrops [].