Keratoconus With Spontaneous Perforation of the Cornea

Spontaneous corneal perforation following acute hydrops in a patient with keratoconus is an exceptionally rare event. Two cases have been reported in the literature; one patient with fistula formation after 2 years of persistent hydrops,1and a young, pregnant woman whose cornea perforated after a course of topical corticosteroids.2We report two cases of spontaneous corneal perforation after acute hydrops in keratoconus. Report of Cases. —Case 1. —A 23-year-old man with a history of keratoconus presented with acutely decreased vision in the left eye of 4 hours' duration. On presentation, visual acuity was corrected to 20/20 in the right eye with a gas-permeable contact lens and 20/400 in the left eye. Results of the slit-lamp examination were remarkable only for keratoconus, with apical scarring in the right eye and central edema consistent with acute hydrops in the left eye. The intraocular pressure was normal bilaterally. The patient,