Therapeutic efficacy of 5% NaCl hypertonic solution in patients with bullous keratopathy

A clinical trial was undertaken to evaluate the efficacy of hypertonic solution (5% NaCl) in patients who have bullous keratopathy (BK). The aim of the study was to define the stage of the disease and the thickness of cornea in micrometers, which would be the threshold for therapeutic approach. This was a prospective study on 70 eyes of 55 patients. Patients were divided in two groups at the beginning of the study. The first group (n=33 eyes) included patients with initial stage of BK: only stromal component of corneal oedema was present. The second group (n=37 eyes) included patients with advanced stage of BK: the epithelial component of the disease with bullae on the corneal surface had already developed. Visual acuity, central and peripheral thickness of cornea and morphology of the disease was recorded before therapy, 7 days and 4 weeks after administration of hypertonic solution. Our results shown that the efficacy of hypertonic solution correlates with the severity of clinical picture in patients with BK. When 5% NaCl hypertonic solution was applied in the early stage of the disease, when only stromal component of corneal oedema was presented, visual acuity and pachymetry readings were significantly improved. The threshold pachymerty measurement of corneal thickness justifying the application of hypertonic solution was 613-694 microm (in the central corneal area), and 633-728 microm (at corneal periphery). It seems reasonable to apply hypertonic solution to the patients who have BK and whose pachymetric values are below mentioned range. In terminal stages of BK, when superficial bullae (epithelial component) had already developed, treatment with NaCl was not effective and patients had to be submitted to penetrating keratoplasty.