Original articleRecurrence of keratoconus characteristics: A clinical and histologic follow-up analysis of donor grafts1☆,
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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2017, American Journal of OphthalmologyCitation Excerpt :This could be partly explained by the fact that CXL increases stiffness and rigidity of donor tissues, which provides favorable conditions for surgical manipulation, consequently preventing distortion of the corneal surface or toroid corneal surface. After all, the suturing technique still is a great challenge to regain the regular corneal geometry for keratoconus.7–9 In previous studies, the recurrence of keratoconus in grafted cornea was confirmed by clinical, topographic, and histologic characteristic of keratoconus.8
Treatment options for advanced keratoconus: A review
2015, Survey of OphthalmologyCitation Excerpt :In the years after surgery, in all eyes requiring a repeat PK for any reason, histopathologic study of the removed donor buttons revealed structural changes consistent with KC including BL disruption and stromal deposits. This suggests infiltration or repopulation of the transplanted tissues with pathologic recipient keratocytes (or possibly even recipient epithelial cells).40 Recurrent KC has likewise been demonstrated after DALK and in fact may be more likely and quicker in onset, because more of the diseased recipient cornea is left unremoved.112,263
Recurrence or Re-emergence of Keratoconus e What is the Evidence Telling Us? Literature Review and Two Case Reports
2014, Ocular SurfaceCitation Excerpt :Retrospective studies involving multiple cases of regrafted keratoconus patients highlight the rarity of recurrent keratoconus and point out that pathological changes may be subtle, making early detection difficult.15-17 Bourges et al proposed that movement of host keratocytes into the donor tissue set the scene for keratoconus to become established in the donor button.15 The view that recurrence of keratoconus is orchestrated by cell migration from host to donor tissue is echoed by retrospective studies involving multiple cases of regrafts.17,18
A review of keratoconus: Diagnosis, pathophysiology, and genetics
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