Late corneal guttae recurrence in bilateral penetrating keratoplasty grafts

Background: To describe a case of guttae recurrence in bilateral corneal grafts in a patient with a known diagnosis of Fuchs endothelial dystrophy, more than three decades following penetrating keratoplasty.

Methods: Case Report.

Results: A 79-year-old White woman presented with declining vision, right eye worse than the left. She had previously undergone bilateral penetrating keratoplasty (P.K.) for Fuchs Endothelial Keratoplasty 35- and 34- years ago, of the right and left eye respectively. The slit-lamp biomicroscopy exam revealed corneal edema as well as presence of guttae affecting bilateral grafts. She underwent PK of the right eye. Histopathological analysis of the removed PK graft showed posterior nodular excrescences consistent with guttae.

Conclusion: Guttae development in corneal grafts is relatively uncommon and the mechanism of this entity remains unclear. The observation of guttae development in transplanted grafts has raised questions surrounding donor cornea screening and evaluation by eye banks, as well as those relating to recipients' genetics and intrinsic factors that lead to guttae recurrence in the transplanted grafts. We herein describe the case of guttae recurrence in bilateral corneal grafts in a patient with a known diagnosis of Fuchs endothelial dystrophy, more than 34 years following penetrating keratoplasty.