Epikeratophakia: histopathological and cultural study

Three epikeratoplasty buttons (one aphakic and two myopic) prepared by the freeze technique were removed two to nineteen months after surgery. A complete morphological and immunohistochemical study was performed on these buttons in order to gain insight into the reasons for epikeratophakia failure. Histopathological studies with light microscopy and scanning and transmission electron microscopy were performed. All three cases showed an anomalous process of re-epithelialization: in the first, the epithelium over the donor cap was almost completely absent, with many abnormalities; in the second, the epithelium was irregular, with a varying number of cell layers and poor adhesion between cells; in the third, the development of an epithelial cyst between the tissue lens and the cornea of the host caused the failure of the epikeratoplasty. The specimens were cultured 'in vitro' and the cells grown typed for HLA antigens. The antigen panel was the same as that of the host. Immunohistochemistry showed CD3- and CD8-positive cells in the stroma, proving the activity of T-suppressor lymphocytes in a cell-mediated immunoreaction.