Acute Hydrops in Keratoconus Masquerading as Acute Corneal Transplant Rejection

PURPOSE:To document 2 cases that developed acute hydrops corneae within the host tissue after corneal transplantation. Subsequent extension across the transplant-host interface led to edema of the transplanted tissue, with consequent misdiagnosis and treatment of acute transplant rejection. METHODS:The patients attended the Anterior Segment Service at Moorfields Eye Hospital, London, UK. RESULTS:Both patients had a reduction in vision, ocular discomfort, and stromal edema of the transplanted button and adjacent host cornea. No break in the Descemet membrane was noted in either case. CONCLUSION:It is important to differentiate hydrops of the host cornea from acute transplant rejection. This distinction will allow the judicious use of steroids and may allay patient anxiety about possible rejection.