Primary graft failure associated with epithelial downgrowth: a case report

Department of Ophthalmology, The University of California, San Francisco, California, USA.
BMC Ophthalmology (Impact Factor: 1.02). 02/2005; 5:11. DOI: 10.1186/1471-2415-5-11
Source: PubMed


Epithelial downgrowth is a rare complication of ocular surgery. While the features of epithelial downgrowth following corneal transplantation are well described, its association with primary graft failure has only been reported once previously. We report a case of primary corneal graft failure (PGF) associated with retrocorneal epithelial cell ingrowth.
A 59 year-old male underwent an uncomplicated penetrating keratoplasty for Fuchs' corneal dystrophy. The patient developed PGF, and a second transplant was performed 5 weeks after the initial surgery. The initial host corneal button and the failed corneal graft were examined with light microscopy. Histopathologic examination of the excised corneal button demonstrated multilaminar epithelial cells on the posterior corneal surface and absence of endothelial cells. DNA extraction and polymerase chain reaction (PCR) for herpes simplex virus (HSV) DNA was performed on the failed corneal graft. Polymerase chain reaction performed on the failed corneal graft was negative for HSV DNA, which has been implicated in selected cases of PGF. Three years following repeat penetrating keratoplasty, there was no evidence of recurrent epithelial ingrowth.
This is only the second report of PGF associated with epithelialization of the posterior corneal button, which most likely developed subsequent to, instead of causing, the diffuse endothelial cell loss and primary graft failure.

Download full-text


Available from: Anthony J Aldave, Sep 23, 2015
16 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Epithelial downgrowth after penetrating keratoplasty in very uncommon. This paper describes a case in which epithelium invaded the anterior chamber through a fistula in the suture scar from a cataract operation 15 years previously. The epithelium completely circled the endothelial margin of the corneal graft but did not advance into the centre of the graft. Traumatized corneal endothelial cells lose their property of contact inhibition, which permits epithelial growth, whereas normal endothelium is able to resist epithelial downgrowth.
    Canadian Journal of Ophthalmology 03/1982; 17(1):29-31. · 1.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We performed a retrospective clinicopathological review of 124 patients with epithelial downgrowth seen over a 30-year-period at the Massachusetts Eye and Ear Infirmary. The purpose of this study was to determine predisposing factors in the development of epithelial downgrowth, diagnostic symptoms and signs, and the results of various types of treatments. The incidence of this condition after cataract surgery was 0.12%, decreasing to 0.08% over the latter decade. 82% of postsurgical patients with epithelial downgrowth presented to the ophthalmologist within one year following surgery, commonly complaining of decreasing visual acuity, red eye, and pain. The most common presenting signs of epithelial downgrowth were retrocorneal membrane, which was seen in 45% of patients, glaucoma in 43%, corneal oedema in 21%, and a positive Seidel test in 23%. We found that a variety of conditions predispose to epithelial downgrowth but that no one factor was present in all cases. Damage to the underlying endothelium, corneal stromal vascularisation, and stromal downgrowth appeared to be important events not emphasised in prior studies. The angle was partially or totally closed in 87% of enucleation specimens. Patients treated surgically underwent fewer enucleations than those treated medically or not treated.
    British Journal of Ophthalmology 02/1989; 73(1):6-11. DOI:10.1136/bjo.73.1.6 · 2.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A patient with epithelial implantation cyst of the iris developed an unreported complication of penetrating keratoplasty. The presence of good wound apposition throughout the postoperative course and the location of the cyst within the iris stroma suggested contamination with epithelial cells by instrumentation at the time of iris surgery. A second set of instruments for intraocular manipulation may avoid this complication.
    American Journal of Ophthalmology 02/1974; 77(1):87-9. DOI:10.1016/0002-9394(74)90611-4 · 3.87 Impact Factor
Show more