1. 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

2. Financial Disclosure Irving Raber, MD, is a speaker for Bausch and Lomb None of the other authors have any financial disclosures

3. 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

4. Methods

5. Results Eight patients had involvement within the interface away from the visual axis.

6. One patient had ingrowth in the interface within the visual axis Slit lampPentacam AS OCT

7. Two had retrocorneal involvement

8. One had retrocorneal and iris involvement

9. One had retrocorneal as well as anterior chamber involvement

10. 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

11. 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

12. 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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