Acute Hydrops Research Articles

Late-onset spontaneous Descemet's membrane detachment in penetrating keratoplasty - A case report

We present a case of acute graft edema due to late-onset Descemet's membrane detachment (DMD) in a penetrating keratoplasty done two decades ago for keratoconus. A 48-year-old male presented with defective vision and redness in the right eye. The absence of the anterior chamber (AC) inflammation, keratitic precipitates, and the presence of glistening reflex in the AC, with a double contour along the inferotemporal graft host junction, suggested an acute hydrops in the graft. An anterior segment optical coherence tomography (ASOCT) confirmed DMD with the absence of an obvious tear. In the region of the double contour, a lamellar flap/fold of DM beyond the graft host junction (GHJ) but within the detachment and stroma was noted. Descemetopexy with intracameral sulfur hexafluoride gas and compression sutures along the region of the double contour restored graft clarity and vision. A DMD should be considered as a possible cause of acute edema and can be often misdiagnosed as graft rejection.

Acute Hydrops After Bowman Layer Transplantation for Keratoconus May Indicate that Descemet Membrane Rupture Is Secondary to Hydrops.

The aim of this study was to review the postoperative course and imaging features of 7 eyes that presented with corneal hydrops after Bowman layer (BL) transplantation was performed for advanced keratoconus to determine the potential mechanisms of hydrops formation. A retrospective analysis was performed of 7 eyes of 5 patients with advanced keratoconus that underwent midstromal BL transplantation at 2 tertiary referral centers and developed acute corneal hydrops on average 64 (±30) months (range 14-104 months) postoperatively. Corneal tomography and anterior segment optical coherence tomography (AS-OCT) images were reviewed to document the postoperative and posthydrops course. For all eyes, the post-BL transplantation course was uneventful until hydrops development. Despite stable postoperative topographies in 5 of 7 eyes, eyes developed hydrops with typical hypodense areas on AS-OCT that were limited to the stromal layers posterior to the BL graft. With AS-OCT (6/7 eyes), 2 eyes showed a break in Descemet membrane, whereas Descemet membrane was intact across the cornea in 2 eyes; in 2 eyes, the images were inconclusive. All patients admitted to continued eye rubbing, and all but 1 had a clinically significant allergy and/or atopic constitution. Most eyes (5/7) showed a relatively quick (visual) recovery within 1 to 4 months after hydrops. Hydrops formation in keratoconic corneas after midstromal BL transplantation may indicate that a break in Descemet membrane is secondary to hydrops development (and not vice versa). With a midstromal BL graft in situ limiting hydrops dimensions, resolution of the hydrops seemed relatively quick with recovery to prehydrops visual acuity in most eyes.

Compression sutures combined with intracameral air injection versus thermokeratoplasty for acute corneal hydrops: a prospective-randomised trial

AimsTo compare the efficacy of compression sutures combined with intracameral air injection (CSAI) and thermokeratoplasty (TKP) for the management of acute corneal hydrops in keratoconus.MethodsIn this multi-centre randomised clinical trial,...

Contact Lens Fitting in Patients with Keratoconus - A Retrospective Assessment of 200 Patients.

Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes. This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting. The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages "1" to "2" (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages "2 - 3" to "4". Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting. The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance.

Late-onset persistent corneal hydrops after crosslinking treated with 24% C3F8

Corneal hydrops can occur in an apparently stable cornea many years after crosslinking. This case describes the management of persistent hydrops unresponsive to conservative treatment. A 31-year-old woman presented with right acute corneal hydrops 9 years after crosslinking for keratoconus. No clear precipitant was identified, and corneal topography had been stable over the past 9 years. The right cornea demonstrated inferior hydrops with gross thickening of the stroma. The hydrops persisted and failed to resolve after 6 months, despite 2 intracameral 14% C3F8 gas injections and topical hypertonic saline. An intracameral concentration of 24% C3F8, with 65% fill of the anterior chamber was performed, with the gas partially released after day 3, resulting in resolution of the hydrops. Corneal hydrops after crosslinking is a rare phenomenon, but it is likely an underreported complication. The hydrops in this case was recalcitrant to conservative measures. An expansile concentration of intracameral C3F8 was used to achieve a full gas fill to tamponade the inferior Descemet tear. Close follow-up is required to monitor for intraocular pressure spikes and perform paracentesis as required.

Spontaneous acute hydrops with intrastromal clefts in pellucid marginal corneal degeneration and its management

Spontaneous acute hydrops with intrastromal clefts in pellucid marginal corneal degeneration and its management

Primary surgical options for acute corneal hydrops: A review.

Acute corneal hydrops usually resolves alone or with medical therapy along the first 4-6 weeks. However, depending on the severity of the corneal edema or the size of the Descemet break, self-healing might be difficult. Years ago, those patients had no more options than corneal transplantation, but surgical alternatives are on the rise in this century. These surgeries are becoming more popular with a variety of techniques relegating penetrating keratoplasty to a residual role. These techniques aim to accelerate corneal healing, reduce the edema, improve visual acuity and prevent from severe complications that may appear if corneal hydrops is not treated rapidly. Feasibility and safety are the favorable aspects of these techniques since the complications rates described remain low. In this review, we emphasize the recently published studies that describe both the techniques and their results.

Impact of COVID-19 Pandemic on Emergency Inpatient Volume at a Tertiary Eye Care Center in Germany with Corneal Main Specialization.

To estimate the impact of the COVID-19 pandemic on emergency inpatient volume in a tertiary eye care center in Germany with corneal main subspecialization. A retrospective review of ocular emergency patients who attended the inpatient unit of the Department of Ophthalmology of Saarland University, Homburg/Saar, Germany during the COVID-19 pandemic, between 1 March and 30 April 2020, in comparison to the same time period in 2019. For each subject, clinical history and surgical reports were reviewed. After 24 March 2020, PCR examinations for SARS-CoV-2 were performed from throat swab specimens in all patients using real-time RT-PCR. Totally, 135 patients were admitted in 2019 and 115 patients in 2020 as emergency cases. The patient age at the time of admission did not differ significantly between the two time periods (63.6 ± 17.9 years vs. 62.5 ± 19.6 years) (p = 0.792), but the average length of hospital stays increased significantly for 2020 (4.0 ± 3.6 vs. 4.4 ± 2.7 days, p = 0.043). The percentage of admissions due to acute corneal hydrops (0% vs. 3.5%) increased significantly from 2019 to 2020 (χ2 = 4.772, p = 0.028), however, there was not a significant difference between the two years for any other diagnosis (χ2 ≤ 3.564, p ≥ 0.059). From 2019 to 2020, the percentage of acute intravitreal anti-VEGF injections decreased significantly (7.9% vs. 1.3%, χ2 = 3.985, p = 0.045), but the proportion of other emergency surgeries did not differ between the two years (χ2 ≤ 3.617, p ≥ 0.057). COVID-19 PCR examination was performed in 66 (57.4%) cases in 2020 and all samples (100%) were negative. The COVID pandemic did not change emergency inpatient volume in our department, but duration of hospital stay was extended on average by 8 hours, mainly due to additional COVID-19-PCR examinations. The proportion of the most frequently performed surgeries did not change remarkably between 2019 and 2020, but with the introduction of Muraine's sutures in 2019, the percentage of admissions with acute corneal hydrops (with or without subsequent surgery) increased for 2020. No urgent surgery had to be postponed due to the COVID-19 pandemic at our department; all operations were performed successfully.

Acute corneal hydrops of presumed traumatic origin: An uncontrolled case series (three horses)

SummaryThis case series describes acute corneal hydrops in three young horses. Due to similarities in the clinical appearance and progression of the disease with that which is reported in humans and cats with acute corneal hydrops, traumatic Descemet’s membrane rupture was suspected to be the underlying aetiology in these equine cases. The horses presented with acute severe corneal oedema with intrastromal bullae formation and anterior bulging of the corneal contour. Focal posterior corneal changes were also seen in two of three cases. Mild anterior uveitis was also present. Other causes of corneal oedema (e.g. glaucoma) were ruled out based on presentation and clinical examination. Treatment approaches were medical and included various combinations of prophylactic topical antimicrobial therapy in case of secondary corneal ulceration, anti‐inflammatory therapy for uveitis, targeted oedema therapy with topical hypertonic saline and corneal cross‐linking, and placement of a temporary partial tarsorrhaphy for corneal tamponade. The outcome was excellent in all cases, with rapid resolution of the ocular changes. Acute corneal hydrops of presumed traumatic Descemet’s membrane rupture origin should be considered in cases of young horses presenting with acute corneal oedema. However, further studies are warranted to better characterise the disease and to try to confirm the suspected aetiology.

Evaluating the safety and efficacy of compression sutures with intracameral perfluoropropane (C3F8) in the management of acute corneal hydrops.

To evaluate the safety and efficacy of using corneal compression sutures with intracameral perfluoropropane (C3F8) in patients presenting with acute corneal hydrops in ectatic disorders. A retrospective analysis was done for 43 eyes of patients of acute corneal hydrops, managed using a combination of intracameral 14% C3F8 and full-thickness compression sutures. Time for resolution of edema, corneal thickness (CT) change on anterior segment ocular coherence tomography (ASOCT), and visual outcomes were assessed. Corneal edema resolved with a mean duration of 14.8 ± 3.5days (range 10-21). The mean CT on ASOCT decreased from a mean of 1437µm (689-2770µm) preoperatively to 543µm (434 -66µm) on the complete resolution of corneal edema. Our results suggest that full-thickness compression sutures and intracameral C3F8 injection can restore the imperviousness of posterior stroma. This technique appears to be a safe and effective technique for faster resolution of corneal edema post hydrops.

Acute corneal hydrops with iatrogenic keratoconus 20 years after radial keratotomy

A 51-year-old man presented with a history of cloudy vision in the left eye with minimal discomfort. On slitlamp examination, he had 4 well-healed radial keratotomy (RK) incisions in each eye. Severe corneal edema was observed in the inferotemporal aspect of the left eye, consistent with acute hydrops. The patient was managed conservatively with observation and frequent topical lubrication for comfort. The clinical signs of corneal edema resolved over a period of several months, with worsened resultant scarring around the 5-o'clock keratotomy incision. Corneal ectasia is an established late complication of RK. Of interest in this case, the area of corneal hydrops was well demarcated because the RK scars formed a barrier against further progression of corneal edema.

How the tophic problems and the rubbing eye behavior may aggravate the presence of keratoconus in trisomy 21

AbstractPurposeDown syndrome is a congenital anomaly caused by non‐dislocation of chromosome 21. Ocular features in trisomy 21 patients, such as changes in corneal collagen composition as well as thinning predisposing to keratoconus are well appreciated. We present a case of unilateral acute corneal hydrops in a young adult with trisomy 21, and the management to prevent corneal perforation yielding a successful visual outcome.MethodA 20‐year‐old man presented in our emergency department due to sudden visual loss and severe left ocular pain. Visual acuity was 20/200 in the right eye, and finger counting in the left. Anterior segment examination revealed pigmented endothelial cells and endothelial cell count reduced to 2583 CD/mm2 in the right eye, as well as a very large central corneal leukoma and corneal ectasia in the right eye. Corneal topography confirmed the presence of an acute corneal hydrops in the left eye as well as milder keratoconus in the right.ResultsApart from topical steroid drops, oral acetazolamide and timolol drops were used to reduce the intraocular pressure on a decompensated cornea with reduced endothelial cell count. Penetrating keratoplasty was eventually necessary. Due to intolerance and insufficient patient ability to use form‐stable contact lenses, a cross‐linking procedure was performed to stabilize the right eye. Both surgeries lead to best‐corrected acuity of 20/50 OU without a need for additional contact lens correction. Surface issues related to trisomy 21 were addressed using topical lubricants.ConclusionIn the presented case, preexisting keratoconus, worsened by frequent eye rubbing of abnormal collagen composition corneas, permits transmission of mechanical forces to thinner exposed tissue, leading to acute hydrops. The extensive corneal tissue damage that occurred with stromal scarring left necessitates keratoplasty to successfully restore vision. This case highlights the need for preventive ophthalmic examinations in patients of trisomy 21 to rule out the presence of keratoconus. The timely application of lubricants, as well as anti‐histamines and mast cell stabilizers could reduce the eye rubbing behavior that aggravates corneal anomalies in such mentally handicapped individuals. This may reduce progression and eventual need for surgical interventions.

Descemet’s Tear: Sine Qua Non of Acute Hydrops in Primary Congenital Glaucoma

Descemet’s Tear: Sine Qua Non of Acute Hydrops in Primary Congenital Glaucoma

Pediatric Keratoconus: Topographic, Biomechanical and Aberrometric Characteristics

This study sought to evaluate the demographic profile, clinical features, topographic features, and biomechanical and aberrometric characteristics in pediatric keratoconus (KC). Cross-sectional study. Pediatric KC cases <18 years of age were evaluated at a tertiary hospital. Main outcome measurements were demographic profile, clinical features, visual acuity, corneal topography, aberrometry, and biomechanical and confocal microscopy findings. A total of 116 eyes of 62 consecutive patients were recruited with a mean ± age of 14.7 ± 2.77 years (range: 8-18 years); 46 of 62 (88%) were males; 57 of 62 cases (92%) had bilateral disease; 53 of 116 eyes (46%) had progressive KC; and 9 of 116 eyes (8%) had acute hydrops. Systemic associations were found in 6 of 62 patients (9.7%) and ocular associations in 77 of 116 eyes (66.3%); 68 of 116 eyes (58.6%) had associated vernal keratoconjunctivitis (VKC). Among eyes with VKC, 29 of 68 eyes (46%) were in stage IV KC, versus 25% of eyes with no VKC (P= .004). The mean ± SD refractive spherical equivalent was-4.72 ± 3.32 diopters (D), and refractive astigmatism was 3.69 ± 3.09 D. The mean values of maximum keratometry, thinnest pachymetry, and corneal higher-order aberrations were 60.89 ± 10.9 D, 396.05 ± 95.03μm, and 1.18 ± 1.2μm, respectively. Values of corneal hysteresis and corneal resistance factor correlated with the stage of KC (r=-0.26; P= .007). Pediatric KC was commonly associated with VKC in this cohort. Eyes with VKC had more severe KC than those without VKC. Nearly half of the patients presented with progressive disease. Corneal biomechanical changes correlated well with stage of KC in this pediatric age group.

ENDOTHELIAL CELL CHANGES AFTER CORNEAL CROSS-LINKING IN KERATOCONUS

Introduction (CXL) with riboflavin and (UVA) is a new technique of corneal tissue strengthening by using riboflavin as a photosensitizer and UVA to increase the formation of intra and interfibrillar covalent bonds by photosensitized oxidation. The major indication for the use of CXL is to inhibit the progression of corneal ectasia, such as( KC).AIM OF THE WORKTo evaluate the corneal endothelial cell changes after CXL in cases of KC and its correlation with CCT immediately before UVA exposure.SUBJECTSThe study was a prospective interventional study. Inclusion criteria:Topographic and tomographic evidence of KC.Documented clinical worsening.Minimal corneal thickness >450 μm before epithelial debridement.Completely clear cornea with the absence of any other ocular or systemic disease. Exclusion criteria:Corneal thickness of ≤ 450 μm at the thinnest point.History of herpetic keratitis, concurrent corneal infections, or concomitant autoimmune diseases.Severe dry eye, acute hydrops, severe allergic conjunctivitis, and diffuse central corneal opacity.Advanced KC.Glaucoma, cataract, or vitreoretinal disorders.Pregnancy or lactation.ResultsOur results revealed that endothelial cell count, size, and shape did not decrease after the procedure. 25% of eyes had an increase in corneal thickness (CCT) three months after crosslinking. The subgroup analysis showed a significant correlation between preoperative corneal thickness at the thinnest location immediately before UVA rays exposure and the corneal endothelial parameters (ECD, CV %).There was a statistically significant difference in the endothelial cell density between those with increased CCT and with decreased CCT postoperative.CONCLUSIONSCornealcross-linkingisusuallysafeonendotheliumincorneasabove450microns.TheROCcurveshowedthatthecutoffpointofthecornealthicknessmeasuredbyonlinepachymetryimmediatelybeforeUVAapplicationis388μmandbelowthatvaluemoreendothelialdamageresults.

Acute corneal edema decades after penetrating keratoplasty for keratoconus in eyes wearing scleral contact lenses

PurposeTo report three cases of acute corneal edema occurring decades after penetrating keratoplasty (PK) for keratoconus in eyes wearing scleral contact lenses (ScCLs) with previously clear corneal grafts. MethodsRetrospective chart review of three ScCL wearers presenting for sudden onset pain and blurred vision. Data extracted included clinical presentation, year and reason for PK, ocular medications and comorbidities, contact lens wearing history, results of any ancillary testing available including corneal topography, anterior segment optical coherence tomography (OCT), and specular microscopy surrounding the event, treatment and outcomes of intervention. The number of PK eyes fit with ScCLs in the author’s practice was determined to estimate the prevalence of this event. ResultsThe three patients each had a longstanding PK for keratoconus performed between 33–35 years prior to presentation and recurrent ectasia. Each patient presented with an acute, painful eye and reduced vision either 3 days, 4 months or 9 years after refitting into ScCLs. Each eye had well demarcated focal microcystic epithelial and stromal edema within the graft and crossing the wound margin onto the host cornea. Although a definitive break or detachment of Descemet’s membrane was not visualized, the presentations suggest these were episodes of acute hydrops. ConclusionsLongstanding PKs with recurrent ectasia and acute focal edema suggestive of corneal hydrops is demonstrated in this case series of ScCL wearers. Although similar events have occurred as part of the natural history of post-PK corneas for keratoconus, the proximity of ScCL refitting to two of the events suggests some association.

Effects of Intratympanic Injection of Isosorbide on the Vestibular Function of Animal Models of Endolymphatic Hydrops.

ObjectivesThe aims of this study were to investigate the effects of intratympanic injections of isosorbide on vestibular function in animal models of endolymphatic hydrops and to find a new treatment option for the acute onset of vertigo in Ménière disease (MD).MethodsSeventy male guinea pigs received intratympanic injection of isosorbide (IT-ISB). The animals were divided into three study groups: control, a chronic hydrops model, and an acute hydrops model. Intracochlear drug concentrations were measured using high-performance liquid chromatography. Vestibular function was analyzed using an animal rotator test with bidirectional sinusoidal harmonic acceleration before and after IT-ISB administration. Histological changes were also investigated.ResultsISB successfully permeated the perilymph through the round window membrane (RWM) at all three concentrations (25%, 50%, and 100%). In the chronic hydrops model, while IT-ISB histologically induced a reduction of endolymphatic hydrops, vestibular function was unchanged. In the acute hydrops model, no endolymphatic hydrops was histologically observed, and vestibular symmetry was also preserved after IT-ISB.ConclusionISB passed through the RWM into the perilymphatic space even at lower concentrations. IT-ISB histologically reduced hydrops in the chronic model and preserved symmetrical vestibular function in the acute model. IT-ISB could be a treatment candidate for acute attacks of vertigo in MD.

Case report \u2013 Acute Corneal Subepithelial Hydrops (ACSH) during Micropulse Transscleral Cyclophotocoagulation (MPTSC)

BackgroundTo present an unusual intra-operative complication of micropulse transscleral cyclophotocoagulation (MPTSC).Case presentationA 72-year old Chinese gentleman, who had primary angle closure glaucoma and had received bilateral laser iridotomy, presented with progressive left eye blurred vision (visual acuity of 20/40 OD and 20/200 OS). Examination reviewed left eye central retinal venous occlusion. The intraocular pressure (IOP) was 19 mmHg OS and was on maximally tolerated topical medications. Four weeks later, the left eye was complication by neovascular glaucoma; the IOP was raised to 26 mmHg despite additional oral acetazolamide and remained elevated after pan-retinal photocoagulation as well as cataract extraction by phacoemulsification. MPTSC was performed 8 days after the phacoemulsification. During the procedure, a sudden protrusion was formed on the corneal surface. On-table examination with operating microscope and portable slit-lamp reviewed an intact corneal epithelium with a globular-shaped collection of fluid at the subepithelial layer – acute corneal subepithelial hydrops (ACSH). The anterior chamber was formed and the globe was intact. After approximately 10–15 minutes, the swelling spontaneously ruptured and became a corneal epithelial defect. The defect healed on the tenth day after the event with conservative management. There was no irreversible corneal damage and the patient subsequently underwent a successful second MPTSC of the left eye because of poorly controlled IOP.ConclusionACSH is a possible intra-operative complication of MPTSC. We have proposed the possible mechanisms of ACSH. It is best to exercise caution when using MPTSC shortly after any incisional intraocular surgery.

Corneal hydrops: diagnosis and treatment

Acute corneal hydrops is a pathological condition which clinically presents by marked corneal edema developing due to a break in Descemets membrane.&#x0D; Background. To analyze the results of diagnosis and treatment in patients with acute corneal hydrops.&#x0D; Materials and methods. 42 patients (47 eyes) suffering from acute corneal hydrops were included in the study. This condition appeared on both eyes simultaneously or sequentially in 5 patients. Mean age was 28.7 10.1 years (from 19 to 54 years), 31 men, 11 women. In case of complications or inefficacy of medical therapy surgical procedures were performed: 10% gas (C3F8, SF6) injection into the anterior chamber, amniotic membrane transplantation, partial lamellar keratoplasty, DALK, PKP.&#x0D; Results. Duration of corneal ectasia before acute hydrops occurrence was 12.6 4.6 years. Disease was not diagnosed before in 11.9%. Corneal thickness varied from 692 98 m in focal hydrops to 1200 220 m in total hydrops. Area of edema, height of Descemet detachment and gap between break margins were significantly above in cases of subtotal and total hydrops compared with focal and partial hydrops (2, p 0,001). Injection of 10% gas (C3F8, SF6) in the anterior chamber allowed to significantly accelerating the resolution of this condition in cases of subtotal and total hydrops.&#x0D; Conclusion. Analysis of this case series showed the feasibility of a differentiated approach in the treatment of acute corneal hydrops depending on its severity.

Acute Hydrops in the Fellow Eye of Infants with Primary Congenital Glaucoma after Intraocular Pressure Reduction in 1 Eye

To demonstrate the occurrence of acute hydrops in the fellow eye of infants with primary congenital glaucoma (PCG) treated for glaucoma in 1 eye. Small, observational case series. Three infants with PCG who demonstrated acute hydrops in the fellow eye after treatment of the worse eye. Intraocular pressure (IOP) was lowered surgically in 2 infants and medically in 1 infant with PCG. Two infants underwent combined trabeculotomy with trabeculectomy, and goniotomy was possible in 1 infant. Observation of the fellow eye after lowering IOP in an eye with acute hydrops. Two infants underwent glaucoma surgery in 1 eye and demonstrated acute hydrops in the fellow eye within 1 week. The third infant demonstrated acute hydrops after medically controlling IOP in 1 eye before the scheduled surgery. After surgical treatment, the stromal edema cleared completely in all 3 infants, leaving behind a small area of opacity where the Descemet's tear had healed. Our report demonstrates that the fellow eye of a patient with PCG may be at risk of sudden raised IOP resulting in acute hydrops, and early treatment may help to prevent this phenomenon in the fellow eye.