PURPOSE: To report the clinical appearance and course of intrastromal clefts occurring with acute hydrops in keratoconus. METHODS: In eight patients with bilateral keratoconus, nine eyes developed acute corneal hydrops complicated by intrastromal cleft formation. One patient developed this complication in both eyes. The patients, three female and five male, had a mean age of 20 years (range, 11 to 36 years) and were followed after onset of acute hydrops for a median of 8 months (range, 2.5 to 21 months). The patients in this retrospective study were identified and had been treated at one of two institutional cornea referral practices. RESULTS: In eight of nine eyes with intrastromal clefts, complete cleft closure occurred between 6 weeks and 6 months. In one eye, cleft closure was nearly complete in a patient followed up for only 4.5 months after onset of hydrops. Corneal stromal neovascularization developed in six of the nine of eyes. At the last follow-up visit, four of the six untreated eyes had a best-corrected visual acuity of 20/200 or worse. The patient with intrastromal clefts in both eyes did not develop stromal neovascularization and achieved a contact lens corrected visual acuity of 20/40 or better in each eye without surgical intervention. CONCLUSIONS: Intrastromal cleft formation is a manifestation of corneal hydrops in keratoconus. Single or multiple clefts can occur, and bilateral involvement is possible. Clefts generally close over a period of months, but stromal neovascularization is common and may compromise future graft survival.
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