acute hydrops in grafted cornea resulting from recurrent keratoconus

a 53 year-old woman presented with corneal edema 25 years after uneventful penetrating keratoplasty for keratoconus. she was initially misdiagnosed with acute endothelial rejection; however by observation of descemet’s membrane detachment, a diagnosis of late onset corneal hydrops following corneal transplantation was made. this is a rare complication which may occur many years after penetrating keratoplasty and may be due to recurrence of keratoconus within the grafted cornea. therefore, patients with long standing corneal grafts who present with acute corneal edema should be carefully examined for signs of corneal hydrops.