Preetam Kumar, Shreyas Ramamurthy, Pravin K. Vaddavalli

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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

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

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

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

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

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

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 ± 70.93 0.03/0.16 SD- standard deviation, PBFS- posterior elevation best fit sphere Table-3, Risk factor predication based on topographic parameters

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

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

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

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. 2013 ;96:208-13. 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. 2009 ;28:367-70. 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 198-203.