In deep anterior lamellar keratoplasty (DALK), complications related to baring of the Descemet membrane such as incomplete exposure or perforations are well known.1 Epithelial ingrowth, on the other hand, is rare following anterior lamellar keratoplasty and usually occurs as a sheet of cells across the interface.2 Herein, we report the first case, to our knowledge, of a cystic pattern of epithelial downgrowth in a case of DALK and its subsequent management.