Epithelial ingrowth after Descemet stripping automated endothelial keratoplasty: description of cases and assessment with anterior segment optical coherence tomography.
OBJECTIVE
To describe 5 cases of epithelial ingrowth after Descemet stripping automated endothelial keratoplasty (DSAEK) and the use of anterior segment optical coherence tomography (AS-OCT) to describe the areas of ingrowth.


METHODS
Five cases with epithelial ingrowth after DSAEK were examined with commercially available AS-OCT and/or a novel custom-built ultrahigh resolution (UHR) AS-OCT. Argon laser photocoagulation was also used to confirm epithelial ingrowth on the iris surface. Pathological evidence of epithelial ingrowth was noted in an eye that underwent corneoscleral grafting for extensive ingrowth through a fistulous tract.


RESULTS
Epithelial ingrowth was solely in the graft-host interface in 1 case and in both the interface and retrocorneal and iris surfaces in 4 cases. Argon laser photocoagulation on the iris confirmed epithelial ingrowth in 4 cases. The areas of epithelial ingrowth were imaged in 1 case with the Visante AS-OCT and in 3 cases with an UHR-OCT. In 1 case, block excision with corneoscleral grafting was required.


CONCLUSIONS
Epithelial ingrowth can occur after DSAEK. This series reports 5 cases of epithelial ingrowth into the interface and/or the retrocorneal surface after DSAEK. Imaging with AS-OCT, specifically the UHR-OCT, and argon laser photocoagulation can help confirm the diagnosis. UHR-OCT imaging of the interface and retrocorneal surfaces can provide clues to the origin of epithelial ingrowth. Four cases were observed. One case underwent corneoscleral grafting with histological confirmation of epithelial ingrowth.
Bascom Palmer Eye Institute, Miami, FL 33136, USA. lsuh@med.miami.edu
Leejee H
LH
Suh
Mohamed Abou
MA
Shousha
Roberta U
RU
Ventura
Jeremy Z
JZ
Kieval
Victor L
VL
Perez
Jianhua
J
Wang
Sander R
SR
Dubovy
Steven I
SI
Rosenfeld
William W
WW
Culbertson
Eduardo C
EC
Alfonso
Richard K
RK
Forster
D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000175:diagnosis* / Q000209:etiology; D057111:Descemet Stripping Endothelial Keratoplasty; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D007499:Iris Diseases / Q000175:diagnosis* / Q000209:etiology; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D041623:Tomography, Optical Coherence; D014792:Visual Acuity