June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Imaging of epithelial downgrowth following penetrating keratoplasty by confocal microscopy and high-resolution optical coherence tomography
Author Affiliations & Notes
  • Vivian Lien
    Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA
  • Michael Chen
    Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA
  • Dennis Cortes
    Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA
    Ophthalmology, Pontificia Universidad Católica de Chile, Santiago, Chile
  • Jennifer Li
    Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA
  • Mark Mannis
    Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA
  • Footnotes
    Commercial Relationships Vivian Lien, None; Michael Chen, None; Dennis Cortes, None; Jennifer Li, None; Mark Mannis, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 538. doi:
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    • Get Citation

      Vivian Lien, Michael Chen, Dennis Cortes, Jennifer Li, Mark Mannis; Imaging of epithelial downgrowth following penetrating keratoplasty by confocal microscopy and high-resolution optical coherence tomography. Invest. Ophthalmol. Vis. Sci. 2013;54(15):538.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To report the characteristics of epithelial downgrowth following penetrating keratoplasty using in vivo confocal microscopy (IVCM) and high-resolution anterior segment optical coherence tomography (AS-OCT).

 
Methods
 

A retrospective case review was performed of 3 eyes of 3 patients that developed epithelial downgrowth after multiple penetrating keratoplasties. IVCM images were obtained at various time points using the Heidelberg Retina Tomograph III Rostock Cornea Module (Heidelberg Engineering, Germany) and AS-OCT images were obtained using a high-resolution spectral-domain OCT (Heidelberg Engineering, Germany). In two cases, the diagnosis was confirmed by histopathologic evaluation.

 
Results
 

Three cases developed epithelial downgrowth. In case one, a 40 year-old male with a history of a corneal laceration complicated by fungal keratitis was diagnosed with epithelial downgrowth after undergoing 3 penetrating keratoplasties and placement of a glaucoma drainage device over a 3-year period. In case two, a 48 year-old male with a history of acanthamoeba keratitis developed epithelial downgrowth after undergoing two therapeutic keratoplasties over a one-year period. In case three, a 40 year-old female with a history of perforating fungal keratitis developed epithelial downgrowth after 2 therapeutic keratoplasties over a three-month period. In all three cases, IVCM revealed hyper-reflective nuclei characteristic of epithelium and AS-OCT identified an epithelial layer at the level of the endothelium.

 
Conclusions
 

This report provides useful images of epithelial downgrowth from both IVCM and AS-OCT. These noninvasive imaging modalities may potentially be more sensitive in identifying and monitoring epithelial downgrowth than routine light biomicroscopy.

 
 
Figure 1: A) Slit lamp photo showing diffuse epithelial downgrowth. B) IVCM showing hyper-reflective nuclei of epithelial cells at the level of the endothelium. C and D) AS-OCT with a hyper-reflective epithelial layer posteriorly and growing over the iris. The angle is completely sealed.
 
Figure 1: A) Slit lamp photo showing diffuse epithelial downgrowth. B) IVCM showing hyper-reflective nuclei of epithelial cells at the level of the endothelium. C and D) AS-OCT with a hyper-reflective epithelial layer posteriorly and growing over the iris. The angle is completely sealed.
 
 
Figure 2: A) Slit lamp photo of diffuse epithelial downgrowth with unaffected area centrally. B) IVCM showing hyper-reflective nuclei of epithelial cells at the level of the endothelium. C) AS-OCT with hyper-reflective layer of epithelial downgrowth posteriorly with corresponding uncompromised area centrally.
 
Figure 2: A) Slit lamp photo of diffuse epithelial downgrowth with unaffected area centrally. B) IVCM showing hyper-reflective nuclei of epithelial cells at the level of the endothelium. C) AS-OCT with hyper-reflective layer of epithelial downgrowth posteriorly with corresponding uncompromised area centrally.
 
Keywords: 479 cornea: clinical science • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 596 microscopy: confocal/tunneling  
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