LAUSR

SIGNIFICANCE Corneal cross-linking is a well-established treatment to reduce or halt the progression of keratoconus. This case demonstrates that acute corneal hydrops may develop several years after corneal cross-linking even despite apparent treatment effect with corneal flattening, and patients should be monitored accordingly. PURPOSE This study aimed to describe a case of continued progression in the form of corneal hydrops despite prior corneal cross-linking and evidence of treatment effect. CASE REPORT A 19-year-old woman underwent bilateral accelerated transepithelial corneal cross-linking for progressive keratoconus. At 2 years after the procedure, significant flattening of the central cornea of >3 D was measured in the left eye, indicating a significant treatment response, although continued thinning was noted on tomography. At 3.5 years after the procedure, this eye developed acute corneal hydrops with subsequent corneal scarring necessitating corneal transplantation. CONCLUSIONS Patients should continue to be monitored for several years after corneal cross-linking, and retreatment should be considered if there is progressive corneal thinning.