Hurricane Keratitis in Penetrating Keratoplasty

Graft failure: II. Ocular surface complications

“…Even if the donor epithelium remains on the cornea during surgery, it may not be viable and epithelial abnormalities may occur in the early postoperative period [24,29]. Punctuate epithelial keratitis (PEK), hurricane (vortex) keratopathy, filamentary keratitis, and epithelial defects (ED) along with other types of epithelial abnormalities, are common after PKP, especially in the early postoperative period [1, 30,31]. For example, the prevalence of PEK, ED and hurricane keratopathy after PKP are 63%, 75% and 30 to 70%, respectively [24,30,32,33].…”

Whorl pattern keratopathies in veterinary and human patients

“…Mackman et al employed the term hurricane keratitis to describe a whorl pattern observed on the corneal surface in post‐penetrating keratoplasty patients that became more apparent upon application of topical fluorescein. In a review of the literature, while most reports imply fluorescein retention as an integral element in use of the term hurricane keratopathy/keratititis, others do not .…”

“…This is commonly the case posttransplantation . This pattern has been reported in early postoperative corneal transplants which, when stained with fluorescein, form a characteristic spiral pattern in the central portion of the graft, often extending to the periphery of the transplant (Figure ). This is reported to develop in more than 70% of patients who have had corneal graft surgery, and the distribution of the hurricane pattern is clockwise in 89.2% of eyes .…”

“…This is reported to develop in more than 70% of patients who have had corneal graft surgery, and the distribution of the hurricane pattern is clockwise in 89.2% of eyes . Initially, the toxic effects of topical corticosteroid and/or its preservative on the corneal epithelium were suspected as a reason for development of the hurricane pattern . Authors proposed that the grafted epithelium was sensitive to the effects of corticosteroids, as the pattern developed only in the donor button, and patterns were not observed in postcataract corneas that were also exposed to topical steroids.…”

The power of observation

“…SSCE is now an established procedure employed in ocular surface reconstruction either independently or as part of auto or allo limbal transplantation and these rules of corneal epithelial wound healing guide my management of ocular surface injuries (5) . In 1983 the term Hurricane keratitis was coined by Mackman et al (6) , to represent punctate fluorescein staining seen on corneal grafts, resembling the symbol of a hurricane on a weather map. This was attributed to the influence of sutures on the migrating epithelial cells from the limbus.…”