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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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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).
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.
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.
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.
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