Epithelial downgrowth after Descemet membrane endothelial keratoplasty

Le, Viet Nhat Hung ORCID: 0000-0001-9864-782X, Wabnig, Florian, Bachmann, Bjoern and Cursiefen, Claus . Epithelial downgrowth after Descemet membrane endothelial keratoplasty. Eur. J. Ophthalmol.. LONDON: SAGE PUBLICATIONS LTD. ISSN 1724-6016

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DOI:10.1177/1120672120912413

Abstract

Purpose: To describe a patient with epithelial downgrowth after Descemet membrane endothelial keratoplasty. Methods: Case report. Results: A 73-year-old woman underwent triple Descemet stripping automated endothelial keratoplasty for cataract and corneal edema secondary to Fuchs endothelial dystrophy in the left eye elsewhere. Three years later, Descemet membrane endothelial keratoplasty was performed at our department due to graft failure. One month after the operation, her vision improved to 20/32 and maintained stable. At the 14-month visit, her visual acuity decreased, and a routine examination revealed epithelial downgrowth at the posterior surface of the cornea and partly beneath the graft, accompanied by presumed graft rejection. Therefore, repeat Descemet membrane endothelial keratoplasty with epithelial scraping and intracameral injection of 5-fluorouracil was indicated. She recovered 20/25 vision by 1 month after the surgery. However, small sheet-like epithelial downgrowth recurred 1 month later. The epithelial downgrowth was limited to the peripheral margin of the Descemet membrane endothelial keratoplasty graft and did not affect the visual axis. Epithelial downgrowth showed islands with connection between epithelial downgrowth and clear corneal incision on anterior segment optical coherence tomography images. Histopathologic evaluation of the removed Descemet membrane endothelial keratoplasty graft confirmed conjunctival epithelium as the source. Under close observation at the current 4-year follow-up, the epithelial downgrowth remained stable and localized and her vision increased to 20/20. Conclusion: Epithelial downgrowth can occur after Descemet membrane endothelial keratoplasty. The limited progression of epithelial downgrowth in this patient suggests that this condition after Descemet membrane endothelial keratoplasty even in the recurrence stage may cause less damage than expected and may only need to be observed closely if no progression occurs.

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Le, Viet Nhat Hung	UNSPECIFIED	orcid.org/0000-0001-9864-782X	UNSPECIFIED
Wabnig, Florian	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Bachmann, Bjoern	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Cursiefen, Claus	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED