Late corneal acute hydrops in ineffective accelerated transepithelial corneal crosslinking in a patient with keratoconus

A 20-year-old man with a very thin cornea developed acute hydrops with corneal thinning after accelerated transepithelial corneal crosslinking (CXL) for keratoconus. Because the corneal thinning and deformation were progressing, accelerated transepithelial CXL was performed in the right eye. However, corneal thinning still progressed after the procedure. After 3.5 years, blurred vision occurred suddenly and acute hydrops was diagnosed. With a pressure eye patch and ofloxacin ointment, the acute hydrops resolved 2 months after the onset. Corneal thickness and topographic change should be monitored carefully after accelerated transepithelial CXL, especially in patients with thin corneas.