Penetrating keratoplasty after radial keratotomy and recurrent immune overreaction

Abstract

A 32-year-old man suffering from keratoconus was treated with radial keratotomy. Twenty weeks later, he presented visual deterioration, edema and corneal perforation. A penetrating keratoplasty was required. The postoperative course was regular, but after 9 months, the patient presented kerato-uveitis. Subsequent phlogistic relapses occurred approximately every 6 months during the following 5 years. The performed cultures were positive only during the first episode. Radial keratotomy is not indicated in keratoconus. The multiple relapses of kerato-uveitis could not be explained by infection, and we hypothesized that they may be due to a 'traumatic memory' of the cornea caused by the several suffered traumatisms, without clinical features of corneal graft rejection. The risks of new penetrating keratoplasty and cataract surgery are high. As the cornea is the tissue with the highest sensitivity in the body, we tried to explain the relapsing kerato-uveitis as a consequence of the disruption of the nervous corneal network.

Keywords: Kerato-uveitis; Keratoconus; Penetrating keratoplasty; Radial keratotomy; Recurrent immune overreaction; Traumatic memory.

Fig. 1

Corneal findings of 16 radial paracentral scars, white opacity at the superficial and deep corneal stroma, corneal edema and folds of the Descemet membrane. Frontal (a) and lateral (b) view.