Exaggerated subepithelial fibrosis after anterior stromal puncture presenting as a membrane

The aim of the study was to describe the clinical features, histopathological findings, and management of eyes presenting with a thick membrane after anterior stromal puncture (ASP) for bullous keratopathy.

Retrospective interventional case series.

Retrospective chart analysis of 3 eyes presenting with a thick membrane between 12-30 months after ASP was done. Patients presented with complaints of recurrent symptoms of pain, watering, and irritation. The membrane was peeled off from the corneal surface in the operation room and sent for histopathological evaluation. A cryopreserved amniotic membrane was secured on the corneal surface using 10-0 nylon interrupted sutures.

Patients reported alleviation of symptoms after the procedure and remained asymptomatic at the final follow-up (range 6-12 months). Histopathological evaluation of the excised membrane revealed the presence of a hyperplastic epithelium with loose fibrocollagenous tissue suggestive of subepithelial fibrosis.

Subepithelial fibrosis after ASP, although a known entity, may rarely present as a thick membrane because of exaggerated response resulting in the recurrence of symptoms. This can be successfully managed by superficial keratectomy and amniotic membrane transplant.