Recurrence of keratoconus in donor cornea 22 years after successful keratoplasty.

We report a second clinico-pathologic report of recurrent keratoconus in a 43-year-old white female with bilateral penetrating keratoplasties for keratoconus. She was found to have a recurrence of this condition in the right eye as manifested by increasing myopic oblique astigmatism, subepithelial and anterior stromal scarring and corneal thinning, 22 years following the initial grafting procedure. A second successful penetrating keratoplasty was performed. Light and electron microscopy demonstrated abnormalities in the basal epithelium, breaks in the base- ment membrane, duplication and thickening of Bowman's layer, and abnormal stromal keratocytes with accumulation of granular intra-and extracellular material. These findings are consistent with changes as seen in keratoconus.