97th DOG Annual Meeting 1999
SUBEPITHELIAL FIBROSIS AFTER KERATOPLASTY FOR KERATOCONUS - 2 CASE REPORTS
S. Giessler, F. Wilhelm, G. Jendral, U. Hammer, G. Duncker
Beyond conventional therapy, the penetrating keratoplasty allows rehabilitation of vision in case of advanced keratoconus.
According to literature, the percentage of penetrating keratoplasties performed for keratoconus has not changed much in recent years (11-15% , Eye Bank Association of America).
Here we present 2 cases of keratoplasty performed for keratoconus. Both cases experienced a progressive subepithelial fibrosis in the sutural region.
The fibrotic tissue was ablated mechanically and by laser excimer ablation. Postoperativly, in both cases the cornea was clearer and the visual function improved.
Theoretically, fibrosis can be caused by several mechanisms. For example, increased levels of lysozomal enzymes in the basal cells could result in degradation of the underlying stromal tissue, causing the pathologic changes typical of keratoconus. This reaction could also appear after keratoplasty. The cornea may react to degradation of stromal tissues with a fibrotic repair. Finally, fibrosis might follow a local destruction of the cornea by bacterial infection of the suture.