title: Primary graft failure associated with epithelial downgrowth: a case report.
abstract: BACKGROUND
  Epithelial downgrowth is a rare complication of ocular surgery. While the features of epithelial downgrowth following corneal transplantation are well described, its association with primary graft failure has only been reported once previously. We report a case of primary corneal graft failure (PGF) associated with retrocorneal epithelial cell ingrowth.
  
  
  METHODS
  A 59 year-old male underwent an uncomplicated penetrating keratoplasty for Fuchs' corneal dystrophy. The patient developed PGF, and a second transplant was performed 5 weeks after the initial surgery. The initial host corneal button and the failed corneal graft were examined with light microscopy. Histopathologic examination of the excised corneal button demonstrated multilaminar epithelial cells on the posterior corneal surface and absence of endothelial cells. DNA extraction and polymerase chain reaction (PCR) for herpes simplex virus (HSV) DNA was performed on the failed corneal graft. Polymerase chain reaction performed on the failed corneal graft was negative for HSV DNA, which has been implicated in selected cases of PGF. Three years following repeat penetrating keratoplasty, there was no evidence of recurrent epithelial ingrowth.
  
  
  CONCLUSIONS
  This is only the second report of PGF associated with epithelialization of the posterior corneal button, which most likely developed subsequent to, instead of causing, the diffuse endothelial cell loss and primary graft failure.
authors.affiliation: Department of Ophthalmology, The University of California, San Francisco, California, USA. aldave@jsei.ucla.edu
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Aldave
authors.forename: David A
authors.initials: DA
authors.lastname: Hollander
authors.forename: Bruno
authors.initials: B
authors.lastname: Branco
authors.forename: Brooks
authors.initials: B
authors.lastname: Crawford
authors.forename: Richard L
authors.initials: RL
authors.lastname: Abbott
mesh_terms: D002452:Cell Count; D002465:Cell Movement; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004279:DNA, Viral / Q000032:analysis; D003886:Descemet Membrane / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology; D019573:Epithelium, Corneal / Q000473:pathology*; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D012086:Reoperation; D018139:Simplexvirus / Q000235:genetics
chemical_list: D004279:DNA, Viral