Recurrence of Keratoconic Pathology in Penetrating Keratoplasty Buttons Originally Transplanted for Keratoconus

Purpose: Study aimed to examine buttons removed from patients originally grafted for KC (group 1) for signs of recurrence at a cellular level and compare them with buttons removed from patients originally grafted for other conditions (group 2). The study further aimed to compare buttons from group 1 exhibiting high astigmatism (group 3) with the other buttons in the study (group 4). Methods: Together with clinical data, corneal buttons were collected at repeat penetrating keratoplasty and labeled immunohistochemically with a panel of antibodies to structural proteins to assist microanatomical interpretation. Image analysis of montaged images of many individual sections was performed using custom software. The resulting data were analyzed statistically for significant differences between groups 1/2 and 3/4. Results: Little evidence of KC recurrence could be found despite statistically significant differences between groups 1/2 in corneal thinning at both graft-host junction (GHJ) (P = 0.035) and within the graft (P = 0.001), epithelial thickening at the GHJ only (P < 0.001), high astigmatism (P = 0.028), and history of high intraocular pressure (P = 0.032) or rejection (P = 0.002) and between groups 3/4 in corneal thinning at both GHJ (P = 0.002) and within the graft (P = 0.003), epithelial thickening at the GHJ only (P = 0.003), and high astigmatism (P < 0.001). Conclusion: This study has highlighted the rarity of recurrence of KC in transplanted donor corneas and the corresponding difficulty in detecting early signs of the disease.

[1]  M. Dana,et al.  Corneal Graft Rejection , 2009, International ophthalmology clinics.

[2]  C. Lindén,et al.  Laminins in normal, keratoconus, bullous keratopathy and scarred human corneas , 2007, Histochemistry and Cell Biology.

[3]  G. Gamble,et al.  Topographic Indications of Emerging Keratoconus in Teenage New Zealanders , 2007, Cornea.

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

[5]  M. Naderi,et al.  Comparison of the Effect of Three Suturing Techniques on Postkeratoplasty Astigmatism in Keratoconus , 2006, Cornea.

[6]  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.

[7]  L. Laroche,et al.  Late Changes in Refraction, Pachymetry, Visual Acuity, and Corneal Topography After Penetrating Keratoplasty , 2006, Cornea.

[8]  I. Avni,et al.  Penetrating Keratoplasty for Keratoconus: Long-Term Results , 2005, Cornea.

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

[10]  T. Sherwin,et al.  Morphological changes in keratoconus: pathology or pathogenesis , 2004, Clinical & experimental ophthalmology.

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

[12]  B. Seitz,et al.  Impact of graft diameter on corneal power and the regularity of postkeratoplasty astigmatism before and after suture removal. , 2003, Ophthalmology.

[13]  T. Sherwin,et al.  Involvement of corneal nerves in the progression of keratoconus. , 2003, Experimental eye research.

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

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

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

[17]  T. Sherwin,et al.  Cellular incursion into Bowman's membrane in the peripheral cone of the keratoconic cornea. , 2002, Experimental eye research.

[18]  C. McGhee,et al.  Indications for Corneal Transplantation in New Zealand: 1991–1999 , 2002, Cornea.

[19]  J. Streilein,et al.  Dynamics of donor cell persistence and recipient cell replacement in orthotopic corneal allografts in mice. , 2001, Investigative ophthalmology & visual science.

[20]  G. Zaidman,et al.  Postkeratoplasty keratoconus in a nonkeratoconus patient. , 2001, American journal of ophthalmology.

[21]  R. Olson,et al.  Penetrating keratoplasty for keratoconus: a long-term review of results and complications. , 2000, Journal of cataract and refractive surgery.

[22]  K. Pesudovs,et al.  Penetrating keratoplasty for keratoconus: visual outcome and success. , 2000, Ophthalmology.

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

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

[25]  S. Tuft,et al.  Long‐Term Refraction and Keratometry After Penetrating Keratoplasty for Keratoconus , 1995, Cornea.

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

[27]  M. Lawless,et al.  Keratoconus in a donor cornea. , 1994, Journal of refractive and corneal surgery.

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

[29]  E. Traboulsi,et al.  Keratoconus after penetrating keratoplasty. , 1990, Ophthalmic surgery.

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

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

[32]  C. Hanna,et al.  Fate of Cells in the Corneal Graft , 1962 .