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AS Marcon, CJ Rapuano, PR Laibson, EJ Cohen; Recurrence of Corneal Stromal Dystrophies after Penetrating Keratoplasty . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1723.
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Purpose: The objective of this study is to assess the rate of recurrence of stromal dystrophies in corneal grafts. Methods: We conducted a retrospective review of Wills Eye Hospital records from 1984 to 2001, identifying all patients with stromal dystrophies who had penetrating keratoplasties. Recurrence is defined as any clinical findings compatible with recurrence of the disease in the graft button. Clinically significant recurrence is defined as ocurring in the visual axis causing decreased visual acuity (loss of two lines or more, or worse than 20/40) or causing recurrent erosion symptoms. Factors to be analyzed include age, gender, time to recurrence and time to clinically significant recurrence. Results will be analyzed using Kaplan-Meier survival curves. Results: Preliminary results are as follow. Forty-eight patients (77 eyes) were included in this study. Twenty-one patients (35 eyes) were diagnosed with lattice dystrophy (mean follow-up time of 139 months), 10 patients (17 eyes) with dystrophy of Bowman’s membrane (152 months), 8 patients (14 eyes) with macular dystrophy (86 months), 5 patients (7 eyes) with granular dystrophy (145 months), 4 patients (4 eyes) with Schnyder’s crystalline dystrophy (52 months). The mean time for the dystrophy of Bowman’s membrane eyes to show signs of any recurrence (14 eyes) was 34 months and to show signs of clinically significant recurrence (11 eyes) was 52 months. One eye, with a follow-up period of at least 36 months, failed to present with signs of recurrent disease. Of the eyes with granular dystrophy the mean time for any recurrence (3 eyes) was 35 months and 81 months for clinically significant recurrence (2 eyes). Four eyes, with a follow-up period of at least 36 months, did not have signs of recurrence. The mean time for the lattice dystrophy eyes to present with signs of any recurrence was 87 months (21 eyes) and 114 months for clinically significant recurrence (17 eyes). All eyes had evidence of some recurrence during the study period. Of the 14 eyes diagnosed with macular dystrophy only 1 presented with signs of any recurrence, 190 months after the surgery. None of the 4 eyes with Schnyder’s crystalline dystrophy had signs of recurrence during the study period. Conclusion: The corneal dystrophies studied can be successfully treated with penetrating keratoplasty but some degree of recurrence of the original disease in the graft should be expected eventually. Dystrophy of the Bowman’s membrane and granular dystrophy are likely to recur earlier than other stromal dystrophies.
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