PT  - JOURNAL ARTICLE
AU  - Lynette K Johns
AU  - Pia Leon
AU  - Paula Cortes-Barrantes
AU  - Mehenaz Hanbazazh
AU  - David Zurakowski
AU  - Thaddeus P Dryja
AU  - Joseph B Ciolino
TI  - Recurrent keratoconus: an analysis of breaks in Bowman’s layer in corneal grafts
AID  - 10.1136/bmjophth-2022-001225
DP  - 2023 Apr 01
TA  - BMJ Open Ophthalmology
PG  - e001225
VI  - 8
IP  - 1
4099  - http://bmjophth.bmj.com/content/8/1/e001225.short
4100  - http://bmjophth.bmj.com/content/8/1/e001225.full
SO  - BMJ Open Ophth2023 Apr 01; 8
AB  - Objective To study in a masked fashion whether an objective histological feature associated with keratoconus (KCN) occurs in donor corneas in eyes originally receiving a corneal graft for KCN.Methods Two ocular pathologists performed a retrospective masked histological analysis of slides from donor buttons recovered from 21 eyes with a history of KCN undergoing repeat penetrating keratoplasty (failed-PK-KCN), 11 eyes that underwent their first PK due to KCN (primary KCN), and 11 eyes without history of KCN which underwent PK for other conditions (failed-PK-non-KCN). Breaks/gaps in Bowman’s layer served as the pathological feature indicative of recurrent KCN.Results Breaks in Bowman’s layer were present in 18/21 (86%) of the failed-PK-KCN group, 10/11 (91%) of the primary KCN group, and in 3/11 (27%) of the failed-PK-non-KCN group. Pathological evidence suggests that the prevalence of breaks is significantly higher in grafted patients with a history of KCN than non-KCN controls (OR: 16.0, 95% CI 2.63 to 97.2, Fisher’s exact test p=0.0018) with a conservative Bonferroni criterion of p <0.017 to account for multiple group comparisons. There was no statistically significant difference found between the failed-PK-KCN and primary KCN groups.Conclusions This study provides histological evidence that breaks and gaps in Bowman’s layer, consistent with those found in primary KCN, may develop within the donor tissue in eyes with a history of KCN.Data is available upon request.