Amniotic membrane transplantation with cauterization for keratoconus complicated by persistent hydrops in mentally retarded patients

Abstract

Purpose: Vigorous eye rubbing is a cause of extensive hydrops in mentally retarded patients with keratoconus. We describe a new management approach for this condition.

Design: Prospective, noncomparative, consecutive case series.

Participants: Ten eyes of 10 mentally retarded patients aged 18 to 37 years (8 with Down syndrome and 2 with oligophrenia not associated with Down syndrome). All patients had extensive and persistent hydrops in the course of keratoconus that was refractory to traditional therapy.

Intervention: The patients underwent multifocal cauterization of the cornea combined with amniotic membrane transplantation.

Main outcome measures: Corneal protuberance, final corneal thickness, time to hydrops resolution, and postoperative complications were assessed.

Results: Hydrops was successfully resolved in all eyes. The mean initial corneal protuberance (7.6+/-4.2 mm) resolved after 21.4+/-9.5 days in all eyes. Mean final central corneal thickness was 0.47+/-0.11 mm. Extent of initial corneal protuberance, final corneal thickness, and time to resolution were positively correlated with each other.

Conclusions: Amniotic membrane transplantation with cauterization in this series of mentally retarded patients was a highly effective treatment for persistent hydrops related to keratoconus.