Corneal Endothelial Cell Density and Morphology After Acute Hydrops in Keratoconus

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To compare central corneal endothelium cell density and morphology in eyes with keratoconus and unilateral resolved hydrops with the unaffected fellow eye.


Bilateral confocal microscopy was performed 3 months after resolution of acute unilateral hydrops in patients with keratoconus who presented to the King Khaled Eye Specialist Hospital between February 1, 2004, and November 31, 2005.


Twenty-six patients (19 men and 7 women) with a mean age of 22 years (range, 11-36 years) were enrolled in the study. A history of ocular allergy or rigid gas-permeable hard contact lens wear was present in 14 and 12 patients, respectively. The mean interval to resolution of hydrops was 12 weeks (range, 9-14 weeks), after which neovascularization was present in 8 eyes. The mean endothelial cell density in affected and unaffected eyes was virtually identical (2759 vs. 2788 cells/mm2, respectively; P = 0.82), although 5 (19.2%) affected eyes did have endothelial cell density that was >15% less than that of the unaffected fellow eye. Compared with unaffected eyes, there was a mean increase polymegathism in affected eyes from 33% to 35% and a mean decrease in hexagonality from 60% to 55%, but these differences were not statistically significant (P = 0.11 and 0.06, respectively).


Decreased endothelial cell density is uncommon after resolution of acute hydrops, although morphologic changes may be present in a majority of cases.

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