RECURRENT MEESMANNS CORNEAL EPITHELIAL DYSTROPHY AFTER PENETRATING KERATOPLASTY

Purpose. To characterize the histopathology of recurrent Meesmann's co rneal epithelial dystrophy after penetrating keratoplasty. Methods. Po stmortem examination by light and electron microscopy of the eyes of a n 84-year-old patient with Meesmann's dystrophy who underwent a penetr ating keratoplasty in the right eye at age 74 years and a lamellar ker atoplasty in the left eye at age 51 years. Results. In the right eye, the characteristic features of Meesmann's dystrophy were demonstrated in both the donor and recipient corneas. The pathologic findings were limited to the corneal epithelium and included increased thickness, ar chitectural disorganization, loss of cell polarity, increased amounts of intracellular glycogen, presence of intraepithelial microcysts cont aining degenerated cells, and in some cells, the presence of an electr on-dense fibrillogranular material associated with disrupted cytoplasm ic filaments. In the left eye, the corneal findings were consistent wi th but not specific for Meesmann's dystrophy. These included architect ural disorganization, loss of cell polarity, presence of intraepitheli al microcysts, and irregular thickening of the basement membrane in th e donor cornea. Conclusion. Meesmann's corneal epithelial dystrophy is demonstrated to recur after penetrating keratoplasty. This finding su ggests that the abnormalities that lead to the disease are localized t o the corneal epithelial cells and not in the stroma, as previously pr oposed.