Bilateral Simultaneous Penetrating Keratoplasty: A 40-Year Odyssey

Abstract

Purpose: The purpose of this study was to report 40-year follow-up on a case of bilateral simultaneous penetrating keratoplasty (PK) involving a contralateral autograft. Methods: This was a case report. Results: A 39-year-old man developed right corneal scarring and lipid keratopathy from previous herpes zoster keratouveitis with visual acuity of 20/200. The left eye had dense amblyopia with visual acuity of 20/300. In 1980, he underwent right PK using a contralateral autograft and simultaneous left PK with an allograft. The right autograft provided excellent visual acuity until the graft failed 40 years later. The left allograft underwent severe endothelial graft rejection 2 months after surgery with gradual corneal clearance over the next 21 months. The left allograft remained clear through 40 years without graft failure. Conclusions: Long-term useful vision and graft survival were achieved with a penetrating autograft by avoiding endothelial graft rejection in the setting of previous herpes zoster keratitis and the patient being functionally monocular. Despite almost failing from severe endothelial graft rejection in the absence of ocular risk factors, the left allograft recovered and remained clear through 40 years possibly because peripheral host endothelial cells repopulated the donor.