Epikeratoplasty for keratoconus. A clinicopathologic case report

Area of Science:

• Ophthalmology
• Corneal Surgery
• Histopathology

Background:

• Keratoconus is a progressive thinning of the cornea.
• Epikeratoplasty is a refractive surgical procedure.
• This case explores a rare complication following epikeratoplasty.

Observation:

• A 20-year-old male with bilateral keratoconus underwent uneventful epikeratoplasty in the left eye.
• Five years post-surgery, progressive myopia developed, causing contact lens intolerance and spectacle intolerance.
• Penetrating keratoplasty was performed six years after the initial epikeratoplasty.

Findings:

• Microscopic examination of the corneal button revealed hypocellularity and irregular keratocyte distribution within the lenticule.
• Accumulation of periodic acid-Schiff-positive, electron-dense fibrillogranular material was observed at the interface between the lenticule and Bowman's layer.
• These findings suggest a potential biological response or material degradation at the surgical interface.

Implications:

• This case highlights the importance of long-term monitoring after epikeratoplasty.
• Understanding the interface changes may inform future corneal grafting techniques.
• Further research is needed to elucidate the exact mechanism of late-onset myopia post-epikeratoplasty.