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Case-control study of risk factors for acute corneal hydrops in keratoconus
  1. Allon Barsam1,
  2. Nic Brennan2,
  3. Harry Petrushkin3,
  4. Wen Xing2,
  5. Ana Quartilho2,
  6. Catey Bunce2,
  7. Barny Foot4,
  8. Nathaniel Knox Cartwright5,
  9. Anjana Haridas2,
  10. Pavi Agrawal6,
  11. Hanif Suleman7,
  12. Sajjad Ahmad8,
  13. Elisabeth MacDonald9,
  14. Jennifer Johnston10,
  15. Stephen Tuft2
  1. 1Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
  2. 2Moorfields Eye Hospital NHS Foundation Trust, London, UK
  3. 3Clinical and Diagnostic Oral Sciences, Queen Mary University of London, London, UK
  4. 4British Ophthalmic Surveillance Unit, Royal College of Ophthalmologists, London, UK
  5. 5Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
  6. 6Nottingham University Hospitals NHS Trust, Nottingham, UK
  7. 7Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK
  8. 8Royal Liverpool University Hospital, Liverpool, UK
  9. 9Departement of Ophthalmology, Tennent Institute, Glasgow, Strathclyde, UK
  10. 10University Hospital of Wales, Cardiff, UK
  1. Correspondence to Mr Stephen Tuft, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK; s.tuft{at}


Purpose To determine risk factors for the development of acute corneal hydrops in keratoconus in the UK in a case-controlled study.

Methods Between November 2009 and December 2010, we prospectively identified 73 individuals who developed acute corneal hydrops. We then identified 174 controls from nine regions in the UK with keratoconus who had not had hydrops. For cases and controls we recorded demographics and clinical features. Univariate and multivariable logistic regressions were performed to identify risk factors.

Results Univariate analysis suggested strong associations between the odds of hydrops and each of vernal keratoconjunctivitis (OR 4.08, 95% CI 1.45 to 11.49, p=0.008), asthma (OR 2.70, CI 1.34 to 5.47, p=0.006), atopic dermatitis (OR 3.13, CI 1.50 to 6.56, p=0.002), learning difficulties (OR 7.84, CI 2.86 to 21.46, p<0.001), previous hydrops (OR 40.2; CI 6.2 to ∞, p<0.001), black ethnicity (OR 2.98, CI 0.98 to 8.99; p=0.05), visual acuity in the worse eye (OR 8.76 CI 3.86 to 19.88; p<0.001) and minimum keratometry of ≥48 D prior to the hydrops (OR 4.91, CI 1.07 to 22.6, p=0.041). The use of a contact lens correction was also found to be associated with the odds of hydrops (OR 0.08; CI 0.03 to 0.19, p<0.001). Multiple variable regression indicated that having vernal keratoconjunctivitis (adjusted OR (AOR) 15, 95% CI 1.30 to 173.7; p=0.03), asthma (AOR 4.92, CI 1.22 to 19.78; p=0.025), visual acuity in worse eye (AOR 4.11, CI 1.18 to 14.32; p=0.026) and a high keratometry value (AOR 4.44, CI 0.85 to 23.18; p=0.077) were independently associated with the odds of hydrops in subjects with keratoconus.

Conclusion Some individuals with keratoconus are at high risk of developing acute corneal hydrops. These patients could be managed more aggressively to reduce their risk of developing this complication of their disease.

  • Cornea
  • Epidemiology

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