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 basement membrane, duplication and thickening of Bowman's layer, and abnormal stromal keratocytes with accumulation of granular intraand extracellular material. These findings are consistent with changes as seen in keratoconus.