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

Abstract

Vigorous eye rubbing is a cause of extensive hydrops in mentally retarded patients with keratoconus. We describe a new management approach for this condition. Prospective, noncomparative, consecutive case series. 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. The patients underwent multifocal cauterization of the cornea combined with amniotic membrane transplantation. Corneal protuberance, final corneal thickness, time to hydrops resolution, and postoperative complications were assessed. 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. Amniotic membrane transplantation with cauterization in this series of mentally retarded patients was a highly effective treatment for persistent hydrops related to keratoconus.