RT Journal Article
SR Electronic
T1 Recurrent keratoconus: an analysis of breaks in Bowman’s layer in corneal grafts
JF BMJ Open Ophthalmology
JO BMJ Open Ophth
FD BMJ Publishing Group Ltd
SP e001225
DO 10.1136/bmjophth-2022-001225
VO 8
IS 1
A1 Lynette K Johns
A1 Pia Leon
A1 Paula Cortes-Barrantes
A1 Mehenaz Hanbazazh
A1 David Zurakowski
A1 Thaddeus P Dryja
A1 Joseph B Ciolino
YR 2023
UL http://bmjophth.bmj.com/content/8/1/e001225.abstract
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.