A Phony Case of Corneal Ulcer Following RK

A 38-year-old man presented with complaint of sudden onset of whiteness in right eye. The patient was being treated elsewhere as a case of corneal ulcer with no improvement in symptoms since 15 days.
PAst history was significant for the fact that he had undergone Radial Keratotomy (RK) in both
eyes 15 years back.
Slit lamp examination showed a white edematous appearance of cornea with minimal congestion
(Fig. 1) . There were multiple RK scars in both eyes.

Anterior-segment optical coherence tomography (AS-OCT) (Visante) demonstrated an edematous cornea in the center with a localized descemet’s membrane detachment allowing aqueous  into the corneal stroma
(Fig. 2).

Based on clinical examination and AS-OCT findings, a diagnosis of acute corneal hydrops in the right eye was made.
The patient was started on a course of Prednisolone 1%, Homatropine 2%, and oral Acetazolamide for a period of 3 weeks. On follow-up, corneal edema disappeared with improvement of visual acuity to 6/36 on Snellen’s chart at 3 weeks.

Takeaway Message

• The absence of cilliary congestion, pain, anterior chamber reaction and epithelial defect made the diagnosis of corneal ulcer unlikely in this case.
• Although Radial Keratotomy is no longer practiced, older patients who have undergone RK can still present with complications.
• Hydrops, though a rare complication, can be seen in such cases. AS-OCT can be a helpful modality to clearly delineate Descemet’s membrane rupture in such cases