AS-OCT, IVCM find and track epithelial downgrowth after penetrating keratoplasty

Non-invasive imaging modalities, such as high-resolution anterior-segment optical coherence tomography (AS-OCT) and in-vivo confocal microscopy (IVCM) imaging, may be more sensitive to identifying and monitoring epithelial downgrowth, compared with routine light biomicroscopy in patients undergoing penetrating keratoplasty, and will perhaps replace more invasive diagnostics in these patients, according to a recent case review retrospective study published in the November issue of Cornea.

Michael C. Chen, MD, of the University of California, Davis, and fellow researchers, conducted a retrospective case review on two eyes in two patients who had a history of multiple penetrating keratoplasties that developed epithelial downgrowth 4 and 6 months after the most recent penetrating graft.

The first patient was a 48-year-old man with a history of Acanthamoeba keratitis, who developed epithelial downgrowth after undergoing two therapeutic grafts over a 1-year period. The second patient was a 40-year-old man with a history of a corneal laceration, complicated by fungal keratitis, who was diagnosed with epithelial downgrowth after undergoing three penetrating grafts, placement of a glaucoma drainage device, and pars plana vitrectomy over a 3-year period. In both cases, high-resolution AS-OCT imaging identified-at the level of the endothelium-a highly reflective layer and IVCM images revealed round hyperreflective nuclei consistent with epithelium.

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