Amniotic membrane transplantation with cauterization for keratoconus complicated by persistent hydrops in mentally retarded patients.
OBJECTIVE
Vigorous eye rubbing is a cause of extensive hydrops in mentally retarded patients with keratoconus. We describe a new management approach for this condition.


METHODS
Prospective, noncomparative, consecutive case series.


METHODS
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.


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


METHODS
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.
Wylegala
Edward
E
Department of Ophthalmology, Railway Hospital, Katowice, Poland. keros@polbox.com
Tarnawska
Dorota
D
D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000637:transplantation*; D001684:Biological Dressings; D002425:Cautery / Q000379:methods*; D003131:Combined Modality Therapy; D015715:Corneal Edema / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D007640:Keratoconus / Q000150:complications / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity