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Recurrent ectasia in corneal grafts and outcomes of repeat keratoplasty for keratoconus
  1. S V Patel1,2,
  2. J B Malta1,3,
  3. M R Banitt1,
  4. S I Mian1,
  5. A Sugar1,
  6. V M Elner1,4,
  7. R A Tester1,
  8. Q A Farjo1,5,
  9. H K Soong1
  1. 1
    Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2
    Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3
    Department of Ophthalmology, Division of Cornea and External Disease, Santa Casa de São Paulo, São Paulo, Brazil
  4. 4
    Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
  5. 5
    Vision Associates, Toledo, Ohio and the University of Toledo, Toledo, Ohio, USA
  1. Dr H Kaz Soong, WK Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105, USA; hksoong{at}


Aim: 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.

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  • Funding: Supported in part by grants from Fight for Sight (GA07006), Midwest Eye-Banks, Research to Prevent Blindness (SVP as Olga Keith Wiess Special Scholar), and Michigan Institute for Clinical and Health Research New Pilot Clinical Trial Training Grant.

  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by University of Michigan Institutional Review Board.

  • Patient consent: Obtained.