outcomes of penetrating keratoplasty in keratoconus complicated by acute hydrops

purpose: to compare visual and refractive outcomes as well as graft survival after penetrating keratoplasty (pk) in keratoconic patients with or without acute hydrops. methods: in this comparative interventional case series, 14 eyes of 14 keratoconic patients with acute hydrops (group 1) and 37 eyes of 37 keratoconic patients with no history of acute hydrops (group 2) underwent pk. visual acuity, refractive status, keratometry, intraoperative and postoperative complications, and rejection-free graft survival were compared between the study groups. results: mean patient age was 27.6±11.7 years in group 1 and 30.5±10.1 years in group 2 (p=0.37). time interval from the occurrence of acute hydrops to pk in group 1 was 32.0±29.0 days, ranging from 5 to 58 days. mean follow-up period after keratoplasty was 30.5±15.5 months and 28.2±11.4 months in groups 1 and 2, respectively (p=0.9). suture removal was initiated after 7.8±5.7 months in group 1 and after 11.6±7.4 months in group 2 (p= 0.17) and was completed after 16.3±13.2 and 16.7±6.2 months in the same order (p= 0.13). at final follow-up, mean bcva was 0.23±0.10 and 0.15±0.10 logmar (p=0.08), mean spherical equivalent refractive error was -3.57±1.73 and -2.32±2.31 d (p=0.25), and mean keratometric astigmatism was 3.55±1.54 and 4.36±1.78 d (p=0.26) in group 1 and 2, respectively. the two study groups were comparable in terms of rejection-free graft survival. conclusion: pk can be performed successfully in keratoconus complicated by acute hydrops involving more than half corneal surface, which provides clinical outcomes and graft clarity comparable to those without hydrops.