Elsevier

Ophthalmology

Volume 110, Issue 10, October 2003, Pages 1920-1925
Ophthalmology

Original article
Recurrence of keratoconus characteristics: A clinical and histologic follow-up analysis of donor grafts1,

https://doi.org/10.1016/S0161-6420(03)00617-1Get rights and content

Abstract

Purpose

To report on clinical corneal topography, histopathologic analysis, and fine structure findings in failed grafts after penetrating keratoplasty (PK) for keratoconus (KC).

Design

Retrospective, consecutive, interventional case series with histologic and clinical correlation.

Participants

Twelve corneal buttons were obtained from consecutive patients undergoing repeated PK 10 to 28 years after the initial PK for KC. The indication for regrafting was endothelial deficiency in seven cases, irreversible immune graft rejection in two cases, and corneal ectasia in three cases.

Methods

Removed corneal buttons were examined by light and transmission electron microscopy. A potential correlation between the clinical and videokeratoscopic findings and the microscopic structural observations was analyzed.

Results

Preoperative simulated keratometry measured by TMS-1 (Tomey, New York, NY) or EyeSys CAS (EyeSys Technology, Houston, TX) ranged from 49.8 to 66.1 diopters. A pattern compatible with KC characteristics was observed in all cases. Fine structure analysis revealed Bowman's layer disruption or folds and stromal deposits in all corneal buttons. However, central corneal thinning was not present in any of the removed buttons.

Conclusions

Structure changes compatible with the diagnosis of KC were observed in all donor buttons many years after PK on KC recipients. Recurrence of the KC characteristics may result from graft repopulation by recipients' keratocytes, aging of the grafted tissue, or both.

Section snippets

Patients and methods

Table 1 summarizes the causes for regrafting and clinical conditions before removal of the donor button. Regrafting was indicated for endothelial deficiency in seven cases, for irreversible graft rejection in two cases, and for corneal ectasia most suggestive of recurrent KC in only three cases (patients 4, 8, and 12). The mean delay between the first PK and the regrafting was 21.25 ± 4.95 years and ranged between 10 and 28 years.

Refractive and corneal topography changes before repeat penetrating keratoplasty

The indication for regrafting was occurrence of a clinical ectasia of the donor in three cases (patients 4, 8, and 12; Fig 1). Reliable analysis of the refractive changes occurring before repeat PK was available in 9 of the 12 patients. Among these, all patients had an astigmatism ranging between 2.5 and 12 diopters (D). In five cases, the astigmatism was higher than 6 D (Table 1). The histories of the patients revealed that progression of the astigmatism was observed in all cases. When

Discussion

The histopathologic and fine structure analyses of the 12 corneal buttons favored a mechanism of slow but continuous development of typical KC characteristics within the donor corneal graft after PK for KC. Morphologic abnormalities of the Bowman's layer and granular and characteristic perikeratocytic arrangement of the stromal deposits compatible with keratoconic processes were observed in all 12 buttons studied. However, a constant peripheral or central stromal thinning of the graft was not

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    Manuscript no. 220503

    1

    None of the authors has any financial interest in this study.

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