Recurrent macular corneal dystrophy type II 49 years after penetrating keratoplasty

Recurrence of macular corneal dystrophy after keratoplasty is rare. We repo rt light microscopic, immunohistochemical, electron microscopic, and serolo gic findings in a 78-year-old woman who underwent regrafting 49 years follo wing the first penetrating keratoplasty. Examination of the corneal button revealed deposits of glycosaminoglycans in the graft beneath the Bowman lay er, throughout the stroma, and in the endothelium with positive staining fo r antigenic keratan sulfate. By transmission electron microscopy, intracell ular and extracellular deposits of a fibrillogranular material were detecte d in the stroma, Descemet membrane, and endothelium. The serum level of ant igenic keratan sulfate was normal. Our findings indicate that macular corne al dystrophy type II may show late recurrence after penetrating keraloplast y with intense deposition of antigenic keratan sulfate in all corneal layer s.