Case report assisted and written by Andrew Kwon from the Illinois College of Optometry. Presumed graduation date of May 2026.
The patient is a 36-year-old male who has previously been fit in scleral lenses due to severe keratoconus achieving excellent comfort and vision. His BCVA OS was 20/25. His initial Kmax OS was 104.5D, and the thinnest location OS was 145um.
The patient then presented with sudden onset of eye pain and cloudy vision OS. His entering VA OS was CF @ 2F, and slit lamp findings included corneal swelling centrally with scattered bullae and diffuse 2-3+ injection OS. The patient was diagnosed with hydrops and was told to start prednisolone acetate 1% drop and Muro 128 5% drop alternating every other waking hour. With addition to Muro 128 5% ointment qhs. Follow-up in 4 days.
After 7 follow-ups over the span of 3 months, the cornea was adequately resolved. A 2.5mm corneal scar with inferotemporal pupil involvement remained. The patient’s most recent OS scleral lens was then evaluated. Changes included decreasing the central clearance 300um (most likely an effect from the corneal flattening s/p ACH).
His most recent encounter after incorporating the changes resulted in a BCVA OS 20/20 while still remaining satisfactory with the fit and comfort. An updated Pentacam tomography showed a post-hydrops Kmax OS of 64.8D, and the thinnest location OS of 431um.
