title: Recurrence of keratoconus characteristics: a clinical and histologic follow-up analysis of donor grafts.
abstract: OBJECTIVE
  To report on clinical corneal topography, histopathologic analysis, and fine structure findings in failed grafts after penetrating keratoplasty (PK) for keratoconus (KC).
  
  
  METHODS
  Retrospective, consecutive, interventional case series with histologic and clinical correlation.
  
  
  METHODS
  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.
authors.affiliation: Department of Ophthalmology, CRI, Hôtel-Dieu de Paris, Paris, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bourges
authors.forename: Michèle
authors.initials: M
authors.lastname: Savoldelli
authors.forename: Paul
authors.initials: P
authors.lastname: Dighiero
authors.forename: Michael
authors.initials: M
authors.lastname: Assouline
authors.forename: Yves
authors.initials: Y
authors.lastname: Pouliquen
authors.forename: David
authors.initials: D
authors.lastname: BenEzra
authors.forename: Gilles
authors.initials: G
authors.lastname: Renard
authors.forename: Francine
authors.initials: F
authors.lastname: Behar-Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis* / Q000601:surgery; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors