Corneal infection complicating acute corneal hydrops in keratoconus patients

Acute corneal hydrops (ACH) occurs during the follow-up of keratoconus, presenting as severe corneal edema due to Descemet's membrane rupture. Infectious keratitis can cause corneal edema accompanied by corneal infiltrations. However, it is rare for both ACH and infectious keratitis to occur simultaneously. This case series examines the incidence of cases with infectious keratitis complicating ACH in keratoconus and reports its characteristics.

This series describes three (2.7 %) out of 112 patients with ACH who were found to have simultaneous infectious keratitis at the Kyoto Prefectural University of Medicine, Kyoto, Japan, between 2009 and 2023. Descemet's membrane rupture and corneal infiltration were confirmed using anterior segment optical coherence tomography (AS-OCT) or slit-lamp examinations. All three patients were male and had severe atopic dermatitis. The average age of the patients was 46 years (range: 44-49 years). Two out of three patients tested positive for microbiological culture, yielding methicillin-sensitive coagulase-negative Staphylococcus (MSCNS) and methicillin-sensitive Staphylococcus aureus (MSSA). All the patients responded well to appropriate topical antimicrobial therapy.

This case series highlights the potential of corneal infection to complicate ACH in keratoconus, particularly in patients with atopic dermatitis. AS-OCT is useful for determining a precise diagnosis. The similarity in presentation between ACH and infectious keratitis suggests the need for careful clinical assessment and appropriate microbiological investigation.