Purpose: To evaluate the corneal button of primary penetrating keratoplasty of patients diagnosed with congenital aniridia. The study took place at the Instituto Universitario Barraquer and the Centro de Oftalmología Barraquer. Methods: A retrospective analysis of cases diagnosed with congenital aniridia was carried out. We analyzed 13 corneal buttons of 11 eyes with congenital aniridia. We only included those patients who underwent penetrating keratoplasty for the first time. The corneal buttons were analyzed for histological characteristics of the presence of vascularization, the presence or not of Bowman's layer, the thickness of the stroma and Descemet's membrane, and endothelium layer alterations. Results: We found alterations in the epithelium and stroma in all patients, although this loss of architecture was not seen in Descemet's membrane and the endothelial population. Conclusion: Patients with advanced congenital aniridic keratopathy may be good candidates for deep or superficial anterior lamellar keratoplasty for the preservation of normal endothelium and Descemet's membrane, along with limbal stem cell transplantation, to address epithelial and stromal pathology.

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