Recurrent ectasia in corneal grafts and outcomes of repeat keratoplasty for keratoconus

Aim: To analyse cases of recurrent ectasia in donor corneas after penetrating keratoplasty (PK) for keratoconus. Methods: Data on 25 patients (36 eyes) with recurrent ectasia were retrospectively analysed in this study. The main outcome measures were time to development of recurrent ectasia after first PK for keratoconus, change in keratometric sphere and astigmatism between final suture removal and development of recurrent ectasia, status of regrafts for recurrent ectasia, and histopathology of grafts excised for recurrent ectasia. Results: The age at first PK was 32.6 (SD 8.5) years, and ectasia developed 21.9 (7.0) years after PK. The mean keratometric sphere and cylinder increased by 4.2 D and 3.0 D, respectively, between final suture removal and diagnosis of recurrent ectasia. Ectasia was often preceded by thinning without bulging of the recipient stroma at the graft–host junction. Fifteen eyes (13 patients) were regrafted for recurrent ectasia, and histopathology of the excised grafts showed changes characteristic of keratoconus in the donor tissue in all cases. Two regrafts (two eyes of one patient) developed ectasia again, with one eye requiring a third PK to improve vision. Conclusions: Recurrent ectasia was diagnosed on average two decades after PK. Ectatic changes were often bilateral and occasionally recurred after regrafting, suggesting that host cellular and/or biochemical factors may be responsible. Repeat PK for recurrent ectasia is successful in the intermediate term.

[1]  Sanjay V. Patel,et al.  Long-term keratometric changes after penetrating keratoplasty for keratoconus and Fuchs Endothelial dystrophy. , 2008, American journal of ophthalmology.

[2]  Trevor Sherwin,et al.  Laser scanning in vivo confocal analysis of keratocyte density in keratoconus. , 2008, Ophthalmology.

[3]  W. Trattler,et al.  Corneal Ectasia After Laser Vision Correction , 2008, International ophthalmology clinics.

[4]  Sanjay V. Patel,et al.  Keratocyte density and recovery of subbasal nerves after penetrating keratoplasty and in late endothelial failure. , 2007, Archives of ophthalmology.

[5]  A. Dick,et al.  Changes in the balance of the tissue inhibitor of matrix metalloproteinases (TIMPs)-1 and -3 may promote keratocyte apoptosis in keratoconus. , 2007, Experimental eye research.

[6]  G. Akkoyunlu,et al.  Recurrence of Keratoconus in Two Corneal Grafts After Penetrating Keratoplasty , 2007, Cornea.

[7]  C. McGhee,et al.  Corneal innervation and cellular changes after corneal transplantation: an in vivo confocal microscopy study. , 2007, Investigative ophthalmology & visual science.

[8]  D. Musch,et al.  Extended long-term outcomes of penetrating keratoplasty for keratoconus. , 2006, Ophthalmology.

[9]  N. Efron,et al.  A longitudinal case series investigating cellular changes to the transplanted cornea using confocal microscopy. , 2006, Contact lens & anterior eye : the journal of the British Contact Lens Association.

[10]  G. Duncker,et al.  Pellucid marginal corneal degeneration: evaluation of the corneal surface and contact lens fitting , 2006, British Journal of Ophthalmology.

[11]  H. Al‐Mezaine,et al.  Repeat penetrating keratoplasty: indications, graft survival, and visual outcome , 2006, British Journal of Ophthalmology.

[12]  C. McGhee,et al.  Atypical unilateral superior keratoconus in young males. , 2005, Contact lens & anterior eye : the journal of the British Contact Lens Association.

[13]  R. Buckley,et al.  Scleral Contact Lenses: The Expanding Role , 2005, Cornea.

[14]  Sanjay V. Patel,et al.  Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. , 2005, Transactions of the American Ophthalmological Society.

[15]  R. D. Stulting,et al.  Asymmetric Keratoconus Attributed to Eye Rubbing , 2004, Cornea.

[16]  J. Krachmer.  Eye rubbing can cause keratoconus. , 2004, Cornea.

[17]  I. Schwab,et al.  The long-term results of keratoplasty in eyes with a glaucoma drainage device. , 2004, American journal of ophthalmology.

[18]  K. Pesudovs,et al.  Late onset post-keratoplasty astigmatism in patients with keratoconus , 2004, British Journal of Ophthalmology.

[19]  J. Sugar,et al.  Late-Stage Progressive Corneal Astigmatism After Penetrating Keratoplasty for Keratoconus , 2003, Eye & contact lens.

[20]  F. Behar-Cohen,et al.  Recurrence of keratoconus characteristics: a clinical and histologic follow-up analysis of donor grafts. , 2003, Ophthalmology.

[21]  R. Barraquer,et al.  Long-Term Progression of Astigmatism After Penetrating Keratoplasty for Keratoconus: Evidence of Late Recurrence , 2003, Cornea.

[22]  A. Raj.  Keratocyte density in keratoconus. , 2003, American journal of ophthalmology.

[23]  Sanjay V. Patel,et al.  Keratocyte density in keratoconus. A confocal microscopy study(a). , 2002, American journal of ophthalmology.

[24]  A. Thalasselis,et al.  Recurrent keratoconus 40 years after keratoplasty , 2002, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[25]  G. Grabner,et al.  Recurrent Keratoconus in a Patient with Leber Congenital Amaurosis , 2000, Cornea.

[26]  M. Madigan,et al.  Expression of membrane-type 1 matrix metalloproteinase (MT1-MMP) and MMP-2 in normal and keratoconus corneas , 2000 .

[27]  M. Madigan,et al.  Expression of membrane-type 1 matrix metalloproteinase (MT1-MMP) and MMP-2 in normal and keratoconus corneas. , 2000, Current eye research.

[28]  D M Meisler,et al.  Keratocyte apoptosis associated with keratoconus. , 1999, Experimental eye research.

[29]  W. Green,et al.  Analysis of sex-mismatched human corneal transplants by fluorescence in situ hybridization of the sex-chromosomes. , 1999, Experimental eye research.

[30]  R. Buckley,et al.  A study of 530 patients referred for rigid gas permeable scleral contact lens assessment. , 1997, Cornea.

[31]  R. D. Stulting,et al.  The effects of donor age on the outcome of penetrating keratoplasty in adults. , 1997, Ophthalmology.

[32]  C. Rapuano,et al.  Histologic evidence of recurrent keratoconus seven years after keratoplasty. , 1995, American journal of ophthalmology.

[33]  W. Culbertson,et al.  Corneal Disorders in Floppy Eyelid Syndrome , 1994, Cornea.

[34]  W. Green,et al.  Recurrent keratoconus. , 1994, Cornea.

[35]  M K Smolek,et al.  Interlamellar cohesive strength in the vertical meridian of human eye bank corneas. , 1993, Investigative ophthalmology & visual science.

[36]  R. Eiferman,et al.  Superior keratoconus. , 1993, Refractive & corneal surgery.

[37]  A. Proia,et al.  Histopathological Variation in Keratoconus , 1992, Cornea.

[38]  E. Donnenfeld,et al.  Keratoconus associated with floppy eyelid syndrome. , 1991, Ophthalmology.

[39]  T. Mcmahon,et al.  The spectrum of topography found in keratoconus. , 1991, The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc.

[40]  W. M. Bourne,et al.  A 48-year clinical and epidemiologic study of keratoconus. , 1986, American journal of ophthalmology.

[41]  V. Lakhanpal,et al.  Recurrence of keratoconus in donor cornea 22 years after successful keratoplasty. , 1983, The British journal of ophthalmology.

[42]  M. Abelson,et al.  Recurrent keratoconus after keratoplasty. , 1980, American journal of ophthalmology.