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November 14, 2019

Epithelial Invasion Following Descemet Membrane Endothelial Keratoplasty and Associated With Subsequent Central Graft Detachment

Author Affiliations
  • 1Eye Center, Albert-Ludwig University Freiburg, Freiburg, Germany
  • 2Department of Pathology, Albert-Ludwig University Freiburg, Freiburg, Germany
JAMA Ophthalmol. 2019;137(12):1461-1463. doi:10.1001/jamaophthalmol.2019.4566

Epithelial invasion is a rare complication of intraocular surgery or penetrating injury.1 It is caused by implantation of corneal or conjunctival stem or stemlike epithelial cells into the anterior chamber and can lead to loss of visual acuity.2 The occurrence of epithelial invasion has been described for various surgical procedures and shows 3 different growth patterns: cyst formation, growth across the iris, and growth across the inner cornea.1 Epithelial ingrowth into the flap-cornea interface is a known complication after laser-assisted in situ keratomileusis.2,3 Rare cases of epithelial invasion after Descemet stripping automated endothelial keratoplasty with cell growth in the interface have also been reported.4,5 In a previous report of epithelial invasion after Descemet membrane endothelial keratoplasty (DMEK), the cell origin could not be established because of recipient-donor sex similarity.6 This article presents a case of epithelial implantation after DMEK in which the cell origin could be established, showing cell growth within the corneal interface and leading to corneal opacification and central graft detachment on examination 6 months later.

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