Superficial hypertrophic dendriform epitheliopathy post-keratoplasty

To describe a distinct and unusual superficial dendriform keratopathy that can be seen in postkeratoplasty eyes.

Three Caucasian women in their sixth decade of life were referred to the Corneal and External Disease Service at the University of California, Davis, and underwent penetrating keratoplasty for different diagnoses. After keratoplasty, hypertrophic dendriform epithelial lesions were observed. These were refractory to debridement as well as topical antibiotic and steroid combinations. Immunofluorescent antibody testing was performed in all cases to rule out herpetic infection, and the patients were treated with nonpreserved lubricants and medications to eliminate medication toxicity as the cause of the lesions.

All three patients in this series developed raised, hypertrophic epithelial lesions after keratoplasty, which were refractory to therapy. Comfort and mild increase in visual acuity were restored with the use of thin, moderate water content therapeutic contact lenses.

Superficial hypertrophic dendriform epitheliopathy is a distinct syndrome that occurs postkeratoplasty in patients with preexisting chronic ocular inflammation, tear dysfunction, and/or lid disease exacerbated by the toxic effects of postoperative topical medication.