epithelial ingrowth following endothelial keratoplasty ritika dalal, dnb robert s. feder, md, irving...
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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
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Financial Disclosure
• Irving Raber, MD, is a speaker for Bausch and
Lomb
• None of the other authors have any financial
disclosures
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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
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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
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Results• Eight patients had involvement within the interface
away from the visual axis.
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• One patient had ingrowth in the interface within the
visual axis
Slit lamp Pentacam
AS OCT
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• Two had retrocorneal involvement
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• One had retrocorneal and iris
involvement
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• One had retrocorneal as well as anterior chamber
involvement
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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
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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
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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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References• Koenig SB, Covert DJ. Epithelial ingrowth after Descemet stripping automated endothelial keratoplasty. Cornea. 2008;27:727–729.
• Suh LH, Shousha MA, Ventura RU, et al. Epithelial ingrowth after Descemet stripping automated endothelial keratoplasty: description of cases and
assessment with anterior segment optical coherence tomography. Cornea. 2011;30:528–534.
• Saurabh Ghosh, Richard Bonshek, Stephen J Morgan Histologically proven epithelial ingrowth in failed Descemet stripping automated endothelial
keratoplasty (DSAEK) managed by repeat DSAEK, Clinical Ophthalmology Vol. 7, PP. 1035-1040, 2013
• Bansal R, Ramasubramanian A, Das P, et al. Intracorneal epithelial ingrowth after Descemet stripping endothelial keratoplasty and stromal puncture.
Cornea. 2009;28(3):334–337.
• Suh LH, Yoo SH, Deobhakta A, et al. Complications of Descemet’s stripping with automated endothelial keratoplasty: survey of 118 eyes at one institute.
Ophthalmology. 2008;115:1517–1524.
• Culbertson WW. Descemet stripping endothelial keratoplasty. Int Ophthalmol Clin. 2006;46(3):155–168.
• WalkerBM,HindmanHB,EbrahimiKB,etal.Epithelialdowngrowth following Descemet’s stripping automated endothelial keratoplasty [letter]. Arch
Ophthalmol. 2008;126:278–280.
• Prasher P, Muftuoglu O, Hsiao ML, et al. Epithelial downgrowth after Descemet-stripping automated endothelial keratoplasty. Cornea. 2009; 28(6):708–
711.
• Phillips PM, Terry MA, Kaufman SC, et al. Epithelial downgrowth after Descemet-stripping automated endothelial keratoplasty. J Cataract Refract Surg.
2009;35:193–196.
• Gorovoy MS, Ratanasit A. Epithelial downgrowth after Descemet stripping automated endothelial keratoplasty. Cornea. 2010;29: 1192–1194.
• Saelens IEY, Bartels MC, Van Rij G, et al. Introduction of epithelial cells in the flap-graft interface during Descemet stripping automated endothelial
keratoplasty. Arch Ophthalmol. 2009;127(7):936–937.
• Lee JA, Djalilian AR, Riaz KM, et al. Clinical and histopathologic features of failed Descemet stripping automated endothelial keratoplasty grafts. Cornea.
2009;28(5):530–535.
• Sujit Itty, MD et al Clinical Course and Origin of Epithelium in Cases of Epithelial Downgrowth After Decemet Stripping Automated Endothelial
Keratoplasty, Cornea 2014;33:1140-1144