Lewis James Steven, McGhee Charles N J, Meyer Jay
University of Auckland, Faculty of Medical and Health Sciences - Ophthalmology, Auckland, New Zealand.
PLoS One. 2025 May 22;20(5):e0324750. doi: 10.1371/journal.pone.0324750. eCollection 2025.
Keratoconus is a progressive eye disease characterised by thinning and bulging of the cornea, leading to distorted vision. Acute corneal hydrops, a rare and severe complication of keratoconus, occurs when fluid accumulates in the cornea due to a sudden break in its innermost layer, often causing pain, significant visual impairment, and sometimes requiring corneal transplantation. To better understand the risk of disease progression in the contralateral (unaffected) eye, we conducted a retrospective study at two major tertiary hospitals in Auckland, New Zealand. The study included 45 eyes from 45 patients presenting with acute corneal hydrops. Inclusion and exclusion criteria were rigorously applied to ensure that only patients eligible for corneal collagen crosslinking (CXL) at baseline were included, enhancing the clinical relevance of the findings. Patients were followed for a mean duration of 4.73 years. The results showed that 67% of contralateral eyes exhibited progression in at least one tomographic parameter, with 53.3% demonstrating progression in both anterior curvature and corneal thickness parameters. Higher baseline anterior curvature values and male sex were significantly associated with an increased risk of progression (p = 0.022 and p = 0.046, respectively). Nearly half of the eyes with progression had a thinnest corneal thickness of ≥400μm, making them eligible for CXL at initial presentation. However, 36% of these eligible eyes dropped below this threshold over the follow-up period, underscoring the importance of timely intervention to preserve treatment options. These findings highlight the importance of regular monitoring of the contralateral eye following acute corneal hydrops, particularly in male patients or those with advanced baseline disease. Immediate CXL may be considered in select cases to prevent disease progression. This study also emphasises the need for early intervention strategies and targeted healthcare services for populations at higher risk, including Māori and Pacific Peoples in Aotearoa-New Zealand, who experience disproportionately high burdens of keratoconus and health inequities.
圆锥角膜是一种进行性眼病，其特征是角膜变薄和膨出，导致视力扭曲。急性角膜水肿是圆锥角膜一种罕见且严重的并发症，当角膜最内层突然破裂导致液体在角膜中积聚时就会发生，常引起疼痛、严重视力损害，有时需要进行角膜移植。为了更好地了解对侧（未受影响）眼疾病进展的风险，我们在新西兰奥克兰的两家主要三级医院进行了一项回顾性研究。该研究纳入了45例患有急性角膜水肿患者的45只眼睛。严格应用纳入和排除标准以确保仅纳入基线时符合角膜胶原交联（CXL）条件的患者，从而增强了研究结果的临床相关性。对患者进行了平均4.73年的随访。结果显示，67%的对侧眼在至少一个断层扫描参数上表现出进展，53.3%的对侧眼在前曲率和角膜厚度参数上均表现出进展。较高的基线前曲率值和男性与进展风险增加显著相关（分别为p = 0.022和p = 0.046）。近一半进展的眼睛最薄角膜厚度≥400μm，使其在初次就诊时符合CXL条件。然而，在随访期间，这些符合条件的眼睛中有36%降至该阈值以下，这突出了及时干预以保留治疗选择的重要性。这些发现强调了急性角膜水肿后对对侧眼进行定期监测的重要性，特别是在男性患者或基线疾病较严重的患者中。在某些情况下可考虑立即进行CXL以防止疾病进展。这项研究还强调了针对高危人群，包括新西兰奥特亚罗瓦的毛利人和太平洋岛民，制定早期干预策略和有针对性的医疗服务的必要性，这些人群患圆锥角膜的负担过高且存在健康不平等问题。
