Long-term microstructural changes following epikeratophakia: in vivo confocal microscopy study

Area of Science:

• Ophthalmology
• Corneal Science
• Microscopy

Background:

• Epikeratophakia was a historical surgical procedure for correcting refractive errors, often in cases of congenital cataracts.
• This study examines the long-term corneal microstructural changes 17 years post-epikeratophakia using in vivo confocal microscopy.

Observation:

• Laser scanning in vivo confocal microscopy was used to examine the cornea of a patient 17 years after epikeratophakia.
• The examination focused on the grafted lenticule and host cornea, including keratocyte density, nerve plexus, and endothelial cell morphology.

Findings:

• Reduced keratocyte density was observed in both the grafted lenticule and host stroma.
• Unusual hyperreflective branching structures were noted in the anterior stroma of the host cornea.
• The sub-basal nerve plexus was present but showed reduced density, and the host endothelium resembled Fuchs endothelial dystrophy.

Implications:

• Epikeratophakia leads to dramatic, widespread microstructural changes in the cornea over 17 years.
• In vivo confocal microscopy provides valuable insights into cellular-level corneal adaptations after epikeratophakia.
• Understanding these long-term changes is crucial for evaluating the legacy of historical corneal grafting techniques.