Table of Contents

Table of Contents


Letter from the Editor

Literature Review

Donors with Melanoma History: The Risk to Ocular Tissue Recipients

Original Research

Keratoconus Following Bilateral Corneal Transplants: An Unusual Case Report and Literature Review

Morphological Screening of Donor Corneal Tissue for Previous Refractive Surgery

Practice-Related Material

Processed Tissue Customization: Development of an Operator-Specific Nomogram for Eye Bank Pre-cut Tissue for DSAEK

Eye Bank Finances in the 21st Century: Tools to Educate Leaders for the Eye Bank of the Future

Evaluation of New Prototype for Corneal Transportation in Eye Banking

Keratoconus Following Bilateral Corneal Transplants: An Unusual Case Report and Literature Review


Asher Neren, MD; Julie Linden Soto MD, Robert Nick Hogan MD, Dwight Cavanagh MD, PhD


atopy, cornea, penetrating keratoplasty, vernal keratoconjunctivitis, keratoconus


Purpose:  To report a rare case of clinical keratoconus (KC) in bilateral penetrating grafts confirmed by electron microscopy at the time of repeat penetrating keratoplasty (PK).

Methods:  A case review of a female patient with bilateral severe vernal keratoconjunctivitis (VKC) who underwent bilateral corneal transplants in 1983 at age 12 for indolent vernal ulcers that progressed to descemetoceles and perforated. She subsequently underwent repeat PK’s in both eyes (right eye (OD):2010; left eye (OS):1987) and twenty-seven years later, had developed KC in both transplants.  The patient underwent topography and anterior segment ocular coherence tomography (OCT), and the corneal button from her repeat PK OD was sent for electron microscopic (EM) evaluation. A comprehensive literature review was performed evaluating the occurrence of KC in both lamellar and penetrating corneal transplants.

Results:  EM and histopathologic findings from the corneal button from the repeat PK OD revealed central loss of bowman’s layer, peripheral thinning of the corneal stroma, thickening of the epithelium at the site of stromal thinning, and several fragments of descemet’s membrane embedded in the posterior corneal stroma, all consistent with KC. Topography and anterior segment OCT of both repeat PK’s and her own corneal tissue revealed similar changes consistent with KC.

Conclusions:  Late development of KC in corneal transplants occurs with increasing frequency over time and is more prominent in older corneal donors. Although the exact cause(s) of KC seen in this patient’s own cornea and bilateral grafts is unknown, the risk appears to be associated with her possible genomic predisposition and her history of severe atopy and VKC.  Younger atopic patients undergoing PK should therefore be cautioned that late development of KC may occur.

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