Recurrent Keratoconus in a Corneal Graft after Deep Anterior Lamellar Keratoplasty
A 21-year-old man with advanced keratoconus of the right eye underwent DALK in March 2006. He had no history of allergic diseases such as vernal keratoconjunctivitis and atopy, or any previous ocular/systemic disorders and surgeries. DALK using Anwar’s big-bubble technique was attempted but failed to yield a bare DM, therefore layer-by-layer manual dissection employing a crescent blade (Alcon Laboratories, Fort Worth, TX, USA) was performed to remove as much corneal stroma as possible. An 0.25 mm-oversized corneal graft (8.50 mm) was harvested from a male donor aged 20 years. Death-to-preservation time was less than 30 hours while preservation-to-transplantation time was 72 hours. After DM and endothelium removal, the donor cornea was secured to the recipient bed with 8 separate 10-0 nylon sutures accompanied by a single running 10-0 nylon suture (Sharpoint, Angiotech, Vancouver, BC, Canada).\nThe postoperative course was uneventful and selective removal of the separate sutures was started after 6 months, and completed by month 12 with removal of the running suture. Thereafter, manifest refractive error dramatically changed from +2.5-1.0×180 at month 14, to -2.75-6.0×180 at month 49 (at the last visit prior to regrafting) which provided best-corrected visual acuity of 20/80. Meanwhile, slit lamp examination revealed a centrally bulging graft with Vogt’s striae in the posterior stroma and an intact donor-recipient interface (). Additionally, there was a scissor reflex on retinoscopy and inferior steepening of the graft on corneal topography (). With a diagnosis of recurrence of keratoconus in the graft, the patient underwent PK in March 2011; the full thickness of the corneal disc containing donor epithelium and stroma together with recipient DM and endothelium were submitted in 10% formalin for histopathological evaluation.\nThe eye that received the mate tissue belonged to a young girl with congenital glaucoma who underwent PK for corneal opacity. This graft had rapidly failed and was replaced with another graft after 1 month.