Postkeratoplasty keratoconus in a nonkeratoconus patient.

Abstract

To determine whether postkeratoplasty keratoconus is caused by a recurrence of the host disease or transferred from the donor. 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. 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. 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.