title: Recurrent ectasia in corneal grafts and outcomes of repeat keratoplasty for keratoconus.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Patel
authors.forename: J B
authors.initials: JB
authors.lastname: Malta
authors.forename: M R
authors.initials: MR
authors.lastname: Banitt
authors.forename: S I
authors.initials: SI
authors.lastname: Mian
authors.forename: A
authors.initials: A
authors.lastname: Sugar
authors.forename: V M
authors.initials: VM
authors.lastname: Elner
authors.forename: R A
authors.initials: RA
authors.lastname: Tester
authors.forename: Q A
authors.initials: QA
authors.lastname: Farjo
authors.forename: H K
authors.initials: HK
authors.lastname: Soong
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000209:etiology; D003315:Cornea / Q000473:pathology; D004108:Dilatation, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000473:pathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult