Secondary gelatinous-like keratopathy in corneal graft

Purpose: To describe the appearance of gelatinous-like keratopathy in a corneal graft. Methods: A 42-year-old healthy white man underwent phacoemulsification and placement of a posterior chamber intraocular lens. After the procedure, he developed pseudophakic bullous keratopathy and underwent 2 subsequent corneal transplantations because of failure of the primary corneal graft. Results: Over 14 months after the second transplantation, a flower-like gelatinous keratopathy appeared in the corneal transplant. The patient underwent superficial keratectomy, removal of the continuous suture, topical application of nitomycin C, and placement of therapeutic contact lens until reepithelialization. The condition did not recur in a follow-up of 6 months. Histologically, hyperplastic epithelium, subepithelial fibrosis, and hyaline material were noted. Conclusion: Secondary gelatinous-like keratopathy may rarely affect corneal grafts causing a decrease in visual acuity. It may be a rare pathologic response to chronic pathophysiologic stress. Superficial keratectomy and application of topical mitomycin C with careful follow-up of the corneal graft may improve the visual outcome.