Acute hydrops occurs in approximately 3% of eyes with keratoconus.¹ The incidence increases dramatically in eyes with associated vernal keratoconjunctivitis.^2,3 Neovascularisation rarely develops after resolution of acute hydrops although it has been reported with large area of involvement with hydrops associated with either close proximity to the limbal vascular arcades⁴ or intrastromal clefts.⁵ The association between patient age and area of involvement of hydrops, with the subsequent risk of development of neovascularisation, has not been adequately addressed in a prospective clinical trial.

In Saudi Arabia, patients present with severe keratoconus at a much younger age than in Western populations and have a higher incidence of associated atopic eye disease.^2,3 The average age at the time of penetrating keratoplasty in our patient population is 19 years, with …