Acute hydrops in keratectasia after radial keratotomy

A 28-year-old male who underwent uneventful radial keratotomy for myopic correction 8 years earlier presented with sudden decrease in vision in the right eye. Slitlamp examination revealed 16 healed radial corneal scars in both eyes along with marked corneal edema and conjunctival congestion in the right eye. The Scheimpflug cross-sectional image of the right cornea displayed an intrastromal aqueous cleft in communication with the anterior chamber, consistent with the diagnosis of acute hydrops. The topographic and pachymetric analysis of the left eye revealed increased paracentral elevation of the anterior and posterior corneal surfaces along with inferotemporal thinning, consistent with the presence of keratectasia in the fellow eye. The hydrops resolved with subsequent corneal scarring 2 weeks after medical therapy with topical steroids, hypertonic saline, cycloplegics, and lubricants. This case emphasizes the importance of a comprehensive preoperative topographic assessment to rule out subclinical keratoconus to minimize complications such as keratectasia and hydrops.