Interface opacities in epikeratophakia
K. S. Morgan and R. W. Beuerman
Although small, peripheral, cystic, or putty-gray infiltrates were observed
along the suture tracks in 20 of 100 pediatric patients after
epikeratophakia at Louisiana State University Medical Center, New Orleans,
they progressed to clinically significant opacities in only three. In one,
the interface material was curetted and the lenticule was reattached. The
removed material was identified histologically as epithelial cells in
varying states of degeneration. In a second case, the graft became hazy and
the opacity involved most of the interface. The lenticule was removed, and
epikeratophakia was again performed. On the posterior surface of the
removed lenticule was a multilayered epithelium that had infiltrated into
adjacent stromal lamellae. In the third case, a clear cyst resolved without
intervention over a five-year period. These cases illustrate the importance
of meticulous removal of all surface epithelium and the necessity for
copious irrigation of epithelial debris intraoperatively. Epithelial
ingrowth should not be confused with bacterial infection. Such opacities
can be treated by curettage or aspiration of the invading material or
removal of the epikeratophakia lenticule if spontaneous resolution does not
occur.
