Aphakic bullous keratopathy (ABK) and pseudophakic bullous keratopathy (PBK) both involve decaying of the cornea that results in swelling, possibly pain, and loss of vision. ABK is the term used when the natural lens has been removed without implantation of an artificial lens, and PBK is reserved for use when an artificial lens implant is present.
What are the results of aging on the cornea?
The health of the cornea is largely related to the number of endothelial cells present. They continually pump fluid from the cornea, thereby keeping it relatively dehydrated and clear. As we age, there is gradual loss of these cells, which varies from person to person. Any kind of intraocular surgery, particularly cataract surgery, with or without a lens implant, may further damage the cornea. This also reduces the number of endothelial cells present. If enough of these cells are lost, the cornea may become chronically swollen. This occurs in both ABK and PBK. Certain complications of eye surgery, uveitis, and trauma to the eye may also result in further endothelial cell loss, thereby increasing the risk for developing of this condition.
Is there pain involved with ABK or PBK?
Pain associated with ABK or PBK may not be present until the development of corneal epithelial bullae, which are similar to blisters on the surface of the eye. If the epithelial bullae rupture, pain may be especially severe. This also increases the risk of corneal infections (ulceration).
What is the treatment for bullous keratopathy?
Treatment is aimed at reducing the corneal swelling. This may sometimes be accomplished with topical 5% sodium chloride solutions or ointment to help draw fluid from the cornea, much like soaking a swollen ankle in Epsom salts. If the eye pressure is increased, glaucoma medications may be used to reduce the pressure, which may further minimize corneal edema. When epithelial bullae rupture, anti-inflammatory agents, 5% sodium chloride solution, topical antibiotics, a dilating agent, and a bandage contact lens or patching of the eye may all be utilized to help heal the ocular surface and resolve the pain.
Is a corneal transplant needed?
If ABK or PBK are severe and irreversible with the above measures, a corneal transplant may be considered.