Purpose: The aim of this study was to describe a case of recurrent granular deposits after non-Descemet baring anterior lamellar keratoplasty (nDALK). Methods: A 28-year-old male with granular corneal dystrophy type I, found to have deposits throughout the anterior and midstroma, underwent nDALK. Three years later, he had a recurrence of the deposits. Slit-lamp photographs and optical coherence tomography were used to document the level of recurrence. Full-thickness penetrating keratoplasty was performed, and the residual host stroma was sent for pathology. Results: Slit-lamp photographs and anterior segment optical coherence tomography confirmed that the recurrent hyaline deposits were confined to the residual host stroma just anterior to Descemet membrane. The anterior lamellar graft and epithelium remained clear. Pathology showed positive staining with Masson trichrome in the host stroma just anterior to Descemet membrane. Conclusions: Previous studies suggest that the recurrence of granular deposits after keratoplasty is usually anterior and may even be epithelial in origin. This case report documents the recurrence of granular dystrophy entirely within the residual host stroma after nDALK. These findings suggest that residual keratocytes may still be a source of recurrence.
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