Diagnosis of epithelial ingrowth after penetrating keratoplasty with confocal microscopy.
OBJECTIVE
To report confocal microscopy use in the clinical diagnosis of epithelial ingrowth after penetrating keratoplasty (PKP).


METHODS
A 36-year-old female patient with keratoconus developed a well-delimited posterior hazy membrane covering the inferior two thirds of the cornea 3 months after an uneventful PKP. A posterior corneal line was present resembling an endothelial graft rejection line, but with no keratic precipitates or corneal edema. Ocular hypertension was not observed. Confocal microscopy was performed to elucidate the diagnosis.


RESULTS
Confocal microscopy showed epithelium and stroma with normal findings. Two distinct cellular types were presented at the endothelium layer. Enlarged endothelial cells were observed in the superior part of the cornea up to the leading edge of the hazy membrane. In the middle and inferior part of the graft, the cells were larger, with polygonal shape and easily recognizable hyperreflective nuclei, suggestive of epithelial cells. With these confocal microscopy findings, the patient was promptly submitted to another PKP. Histologic analysis confirmed the diagnosis of epithelial ingrowth.


CONCLUSIONS
Confocal microscopy imaging technique seems to be a useful tool in the early diagnosis of epithelial ingrowth after PKP.
Forseto
Adriana dos Santos
Ados S
Eye Clinic Day Hospital, São Paulo, Brazil. forseto@uol.com.br
dos Santos
Myrna Serapião
MS
Sampaio
Angélica
A
Mascaro
Vera
V
Nosé
Walton
W
D000328:Adult; D003316:Corneal Diseases / Q000175:diagnosis*; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery; D015948:Keratoplasty, Penetrating; D018613:Microscopy, Confocal / Q000379:methods*; D011183:Postoperative Complications