Postkeratoplasty keratoconus in a nonkeratoconus patient

Abstract

PURPOSE: To determine whether postkeratoplasty keratoconus is caused by a recurrence of the host disease or transferred from the donor. METHODS: Penetrating keratoplasty was performed on the right eye of a 73-year-old woman with pseudophakic bullous keratopathy; her other eye was normal. After keratoplasty, visual acuity decreased secondary to the appearance of irregular astigmatism, central corneal thinning, and stromal striae in the graft. A repeat keratoplasty was performed. Clinical corneal topographic analysis and histopathologic studies were performed. RESULTS: Clinical findings and histopathology of the corneal graft were consistent with keratoconus. The second graft has remained clear for 2 years without signs of keratoconus. CONCLUSION: Classic keratoconus developed in a corneal graft in a patient without preexisting keratoconus. This supports the theory that postkeratoplasty keratoconus may be secondary to transfer of the disease from the donor.