Acute Corneal Hydrops following Post-keratoplasty Suture Removal in Pellucid Marginal Degeneration
A 31-year-old female patient presented with blurred vision in both eyes which was more severe in her left eye. The problem had started 3 years prior to presentation. The condition had been slowly progressive 6 months prior to her first visit. The patient did not use glasses or any optical aids.\nFamily and past history were unremarkable. Best corrected visual acuity (BCVA) was 2/10 and counting fingers at 2 meters with -18.0-5.0 × 70 and -19.0 in her right and left eyes respectively.\nSlit lamp biomicroscopy showed inferior corneal thinning bilaterally about 2 mm above the limbus with a stromal scar involving the central cornea, extending to the inferior area of thinning in her left eye. The remainder of the ocular examination was unremarkable bilaterally. Corneal topography, showed a crab- claw pattern in the right eye and a very irregular pattern in the left one ().\nPK was performed in the left eye and a 7.50 mm sized recipient bed received a 7.75 mm donor with small inferior graft decentration.\nOn the first postoperative day, the patient was found to have a positive Seidel test and mildly shallow anterior chamber (AC); the microleakage was from a suture tract located at the 6 o’clock position of the host-graft junction. There was no apparent wound gap but a small host-graft mismatch was present. The patient was followed while receiving steroid and antibiotic drops; a few days later the leakage ceased and the AC was fully formed.\nThe rest of her postoperative course was uneventful up to 8 months when her last sutures including the one at 6 o’clock were removed. Several days later, the patient developed acute hydrops at the inferior host-graft area mostly involving the recipient cornea (). Seidel test was positive but the AC was formed. Antibiotic drops were started and the eye was patched; 2 days later the leakage stopped and edema in the inferior recipient cornea decreased. One week later there was no leakage and the hydrops disappeared with final uncorrected BCVA of 2/10 ().