Subepithelial fibrosis after myopic epikeratoplasty. Report of a case
S. J. Bechara, H. E. Grossniklaus and G. O. Waring 3rd
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga.
A 29-year-old man with a -22.00-diopter myopia in the right eye underwent a
planar, nonfreeze myopic epikeratoplasty and postoperatively developed a
central subepithelial opacity. The opacity recurred after two superficial
keratectomies; finally, another epikeratoplasty was performed. Light
microscopic examination of the original button showed that the epithelium
was thickened, collagenous subepithelial fibrocellular tissue was present,
and Bowman's layer was focally disrupted. The stroma was edematous and
peripherally scarred with scattered keratocytes. Examination by
transmission electron microscopy revealed keratocytes lying anterior and
posterior to Bowman's layer. The subepithelial fibrocellular tissue
corresponded to an area of a break in Bowman's layer and probably
originated from the donor stroma. The break in Bowman's layer may have been
caused by the microkeratome cuts, but its origin is not certain.
