1. Preetam Kumar, Shreyas Ramamurthy, Pravin K. Vaddavalli
ID: 17619
Utility of Clinical and Topographic Features in Predicting Acute Corneal Hydrops in Keratoconus Patients
Jagadesh C. Reddy,MD
Preetam Kumar, Shreyas Ramamurthy, Pravin K. Vaddavalli
The authors have no financial interests in the subject matter of this presentation

2. Purpose
To identify factors that could predict development of acute corneal hydrops in patients with keratoconus (KCN)
Methods
Study design: Retrospective review of clinical records
Study location: Cornea service, LV Prasad Eye Institute, India

3. Methods
Study ethics: Approved by the institutional review board and was conducted in strict adherence to the tenets of the Declaration of Helsinki
History, clinical features and topography parameters of patients who developed acute hydrops were compared with contralateral eye and patients with severe KCN

4. Methods
Group-1 (19 patients): Patients with acute hydrops in only one eye and had an Orbscan IIz performed within a year before development of hydrops
Group-2 (19 patients): Contralateral eye of patients in group-1
Group-3 (21 patients): Patients with severe KCN

5. Results Parameter Group-1 Mean ± SD Group-2 Group-3 P value
Age at diagnosis of KCN
15 ± 6.13
28 ± 11.13
NA/0.01
Age at hydrops
20 ± 8.76 NA
NA/0.04
Gender, male : female
13:6
17:4
NA/0.36
History of allergy (%)
7 (37)
3 (4)
NA/0.10
Eye rubbing (%)
8 (42)
3(14)
NA/0.05
SD- standard deviation, KCN- keratoconus, NA- not applicable
Table-1, Risk factor predication based on demographics and history

6. Results Table-2, Risk factor predication based on clinical features
Parameter
Group-1
Mean ± SD
Group-2
Group-3
P value
Apical scarring (%)
10(53)
9(50)
19 (90)
0.63/0.01
Vogt’s striae (%)
18(95)
18 (95)
21 (100)
1.0/0.29
Fleisher ring (%)
14(74)
13(68)
20(95)
0.09/0.06
Munsons sign (%)
3(16)
9(43)
1.00/0.06
SD- standard deviation
Table-2, Risk factor predication based on clinical features

7. Results
Parameter
Group-1
Mean ± SD
Group-2
Group-3
P value
Sim K Max
65 ± 2.80
62 ± 6.32
63 ± 7.41
0.14/0.35
Sim K Min
56 ± 6.88
55.22 ± 7.45
55 ± 7.32
0.73/0.22
Sim K astigmatism
-7 ± 8.24
-7 ± 4.31
4 ± 6.44
0.99/0.03
PBFS
67 ± 7.52
65 ± 8.89
64 ± 7.34
0.48/0.12
Thinnest Pachymetry
293 ± 49.72
340 ± 64.10
321 ±
0.03/0.16
SD- standard deviation, PBFS- posterior elevation best fit sphere
Table-3, Risk factor predication based on topographic parameters

8. Orbscan Iiz, Four view map showing severe keratoconus in a patient who
subsequently developed keratoconus

9. Literature review of predictors of hydrops
Parameter
Gaskin 2013
Sharma 2009
Grewal 1999
Present study
Race
yes NS
Age
Family history No
Allergy
Poor vision
Eye rubbing
Yes
Contact lens use
Topography
NS- not studied

10. Conclusions
Younger age, eye-rubbing and higher SimK astigmatism were statistically associated with developing hydrops
Presence of apical scarring seemed to be a protective factor in developing hydrops
In bilateral severe KCN eyes the eye with thinnest pachymetry was at risk of developing hydrops
Predisposing risk factors may help in counseling patients

11. References
Fan Gaskin JC, Good WR, Jordan CA, Patel DV, McGhee CNj. The Auckland keratoconus study: identifying predictors of acute corneal hydrops in keratoconus. Clin Exp Optom ;96:
Sharma R, Titiyal JS, Prakash G, Sharma N, Tandon R, Vajpayee RB. Clinical profile and risk factors for keratoplasty and development of hydrops in north Indian patients with keratoconus. Cornea ;28:
Grewal S, Laibson PR, Cohen EJ, Rapuano CJ. Acute hydrops in the corneal ectasias: associated factors and outcomes. Trans Am Ophthalmol Soc. 1999;97:187-98; discussion