Epithelial Ingrowth Following Endothelial Keratoplasty Ritika Dalal, DNB Robert S. Feder, MD, Irving Raber, MD, Steven P. Dunn, MD, Robert Weisenthal,

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Presentation transcript:

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

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 lampPentacam 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

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 , 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– 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: