Epithelial Ingrowth Following Endothelial

Keratoplasty

Ritika Dalal, DNB

Robert S. Feder, MD, Irving Raber, MD, Steven P. Dunn, MD,

Robert Weisenthal, MD, Joel Sugar, MD

Financial Disclosure

• Irving Raber, MD, is a speaker for Bausch and

Lomb

• None of the other authors have any financial

disclosures

Purpose• To present the largest case series of epithelial

ingrowth/implantation following endothelial

keratoplasty

• Identify the common causes and various clinical

presentations

• To determine the typical clinical course and

treatment

Methods

• Retrospective study of 13 patients

• Reviewed:

• Slit lamp photographs, imaging and histopathology

• Number of surgeries prior to EK and surgical

technique of EK, e.g. if venting incisions performed

• Location of implanted epithelium

• F/U records to determine the natural progression and

management

Results• Eight patients had involvement within the interface

away from the visual axis.

• One patient had ingrowth in the interface within the

visual axis

Slit lamp Pentacam

AS OCT

• Two had retrocorneal involvement

• One had retrocorneal and iris

involvement

• One had retrocorneal as well as anterior chamber

involvement

Results• Venting incisions

• 8 patients had venting incisions performed

• 1 patient had epithelial ingrowth presumed to be related to a venting incision

• Probability that venting incisions caused epithelial ingrowth was low (12.5%)

• Presence of epithelium was easily recognized with slit lamp exam

• Ten patients were observed without evidence of significant progression

• Three patients had surgical treatment to remove the ingrowth

Review of Literature• 20 published cases

• 4 cases reported to have venting incisions of

which one contributed to epithelial ingrowth [25%]

• 9 cases had epithelial ingrowth in the interface,

the remaining cases had ingrowth in the AC +

retrocorneal, interface + retrocorneal or only

retrocorneal

• 6 cases were observed without any intervention

• 14 cases underwent surgical intervention most

common of which was repeat DSEK

Conclusion• Epithelial ingrowth occurs most commonly within the

interface away from the visual axis and typically does not progress

• The presentation of a homogenous gray-white interface opacity seen at slit lamp is characteristic

• AS-OCT, confocal microscopy and scheimpflug imaging are useful diagnostic modalities

• Ingrowth can result from - • venting incisions but rarely does• off center trephination• loose donor or host epithelium being dragged into the eye

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