Aim: To analyse cases of recurrence ectasia in the donor corneas in penetrating keratoplasty (PK) performed for keratoconus.
Methods: Data of twenty-five 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: Age at first PK was 32.6 ± 8.5 years (mean ± SD) and ectasia developed 21.9 ± 7.0 years after PK. 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 (1 patient) developed ectasia again, with the latter 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.