title: Recurrence of keratoconic pathology in penetrating keratoplasty buttons originally transplanted for keratoconus.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, University of Auckland, Auckland, New Zealand. n.brookes@auckland.ac.nz
authors.forename: Nigel H
authors.initials: NH
authors.lastname: Brookes
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Niederer
authors.forename: Doron
authors.initials: D
authors.lastname: Hickey
authors.forename: Charles N J
authors.initials: CN
authors.lastname: McGhee
authors.forename: Trevor
authors.initials: T
authors.lastname: Sherwin
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology; D003315:Cornea / Q000378:metabolism / Q000473:pathology; D003319:Corneal Stroma / Q000378:metabolism; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007640:Keratoconus / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index