Conjunctival Epithelial Ingrowth After Penetrating Keratoplasty

Intraocular Epithelial Ingrowth after Traumatic and Surgical Corneal Injuries

Intraocular epithelial ingrowth is a rare but serious complication of eye surgery or trauma. The diagnosis is challenging but can be aided by techniques such as anterior optical coherence tomography (AS-OCT). This study aimed to compare clinical and histopathological diagnostic data to evaluate the accuracy of AS-OCT. This retrospective analysis focused on patients presenting with suspected epithelial invasion between 2017 and 2022. Clinical data and histopathological findings were analyzed for diagnostic confirmation. Immunohistochemistry using the corneal-specific marker cytokeratin 3 and the conjunctival-specific marker cytokeratin 13 helped to identify the type of invading epithelial cells. Statistical analysis was used to evaluate the effectiveness of AS-OCT for diagnosis. This study included 51 patients who underwent keratoplasty or enucleation. Sixteen cases (31%) of epithelial ingrowth were histologically confirmed. The most common type was the cystic form (82%). Enucleation was required in 25% of patients, mainly due to diffuse epithelial invasion. Immunohistochemistry revealed a conjunctival origin in 82% of the infiltrated cells. AS-OCT showed a sensitivity of 78% and a specificity of 26% in detecting hyperreflective structures associated with epithelial invasion. This study highlights the diverse manifestations of epithelial ingrowth and the need for improved diagnostic techniques, with AS-OCT showing promising results but requiring further validation to avoid misdiagnosis.

Herpes simplex keratitis: A brief clinical overview

The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

Corneal epithelial and fibrovascular downgrowth postcataract surgery with intrastromal bleed: a rare case study with multimodal imaging

A woman in her 60s presented with diminution of vision and redness in her right eye (OD) 1.5 months duration, 10 months post cataract surgery. The best-corrected visual acuity (BCVA) on the OD was fingers counting at 0.5 m. The anterior section of the OD demonstrated superior pre-Descemet's intrastromal bleeding, superior dense fibrovascular growth in the corneal mid-stroma and superior fibrovascular downgrowth measuring 5×5 mm in the anterior chamber. Along with topical prednisolone acetate (1%) suspension 4 times per day on a tapering dose, antivascular endothelial growth factor therapy was administered intrastromally and subconjunctivally in the superior bulbar conjunctiva near limbus (0.05 mL of 2.5 mg/0.1 mL at each site). Over the course of a week, the intrastromal bleed had completely stopped. Three months later, at the final follow-up, the BCVA had marginally improved to fingers counting 2 m, with a lingering 4×4 mm nebulomacular scar.

[Epithelial ingrowth after anterior lamellar keratoplasty (clinical observation)]

Epithelial ingrowth (EI) is a rarely occurring complication of surgeries on the anterior eye segment characterized by migration and proliferation of epithelial cells along the wound tract or into the anterior chamber. Several decades ago, EI often led to severe complications, including enucleation. Modern treatment methods allow not only removing the pathological focus of EI, but also minimizing the risk of its reoccurrence. This article presents a clinical case of EI after anterior lamellar keratoplasty involving formation of implant bed under the pathological focus without cutting open the interface zone. The technique helps minimize dissemination of epithelial cells in the area of the lesion. To prevent growth reoccurrence, the method was supplemented with application of a cytostatic agent. The treatment resulted in stable remission throughout the follow-up period (26 months).

Epithelial downgrowth leading to graft rejection after penetrating keratoplasty

PURPOSE

To report a case of epithelial downgrowth after penetrating keratoplasty.

CASE DESCRIPTION

A 58-year-old man presented with graft rejection in his three-month-old, repeat penetrating keratoplasty. Examination revealed centripetal opacification of the posterior cornea due to deep epithelization. He had new retro-corneal membranes and anterior uveitis. Specular microscopy and anterior segment optical coherence tomography were performed, and a clinical diagnosis of epithelial downgrowth was made. The patient had intracameral injections with 5-fluorouracil (5FU) and achieved resolution of intraocular findings after treatment.

CONCLUSIONS

Epithelial downgrowth is an uncommon complication of penetrating keratoplasty. It affects the patients' visual acuity and graft survival. Clinical observation is preferred in severe cases due to the high risk of intraocular damage; intracameral 5FU promises to be a good option in these cases.