Dalal Ritika R, Raber Irving, Dunn Steven P, Weisenthal Robert, Sugar Joel, Hannush Sadeer, Epstein Randy, Feder Robert S
*Private Practice, Mumbai, India; †Wills Eye Hospital, Philadelphia, PA; ‡Michigan Cornea Consultants, Southfield, MI; §Department of Ophthalmology, Upstate Medical University, Syracuse, NY; ¶Department of Ophthalmology, University of Illinois at Chicago (UIC); ‖Department of Ophthalmology, Rush Medical College, Chicago, IL; and **Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
Cornea. 2016 Apr;35(4):465-70. doi: 10.1097/ICO.0000000000000775.
To present a large case series of epithelial ingrowth or implantation following endothelial keratoplasty (EK) with the purpose of identifying the common causes as well as the various clinical presentations. We aim to determine the typical clinical course and the most effective treatment for this rare but serious complication.
This is a retrospective study of 13 patients who developed epithelial ingrowth or implantation post-EK. Slit lamp photographs were independently examined along with other diagnostic imaging and histopathology to confirm the diagnosis. Patient medical records including operative reports were reviewed to determine the number of surgeries that occurred before EK and details of surgical technique, for example, whether venting incisions were performed. Records from follow-up visits were reviewed to determine the natural progression and management of these cases. The literature was reviewed and a meta-analysis was performed.
The patients were divided into 5 groups according to the type of epithelial presentation. Eight patients had involvement within the interface away from the visual axis. One patient had ingrowth in the interface within the visual axis, 2 had retrocorneal involvement, and 1 had anterior chamber involvement. One had both retrocorneal and anterior chamber involvement. Venting incisions were performed in 8 patients, but only 1 had ingrowth related to the venting incision. Nine patients were observed without evidence of significant progression. Four patients had surgical treatment to remove the epithelium.
Epithelial ingrowth or implantation occurs most commonly within the interface away from the visual axis and typically does not progress. The presentation of a homogeneous gray-white interface opacity is characteristic. Ingrowth can result from venting incisions, but rarely does. Other causes are eccentric trephination or loose donor or host epithelium being dragged into the eye at the time of surgery.
呈现一系列大量内皮角膜移植术（EK）后上皮内生或植入的病例，以确定常见病因及各种临床表现。我们旨在确定这种罕见但严重并发症的典型临床病程及最有效的治疗方法。
这是一项对13例EK术后发生上皮内生或植入患者的回顾性研究。裂隙灯照片与其他诊断性影像学检查及组织病理学检查结果独立分析以确诊。查阅患者病历，包括手术报告，以确定EK术前的手术次数及手术技术细节，例如是否进行了排气切口。查阅随访记录以确定这些病例的自然病程及处理情况。查阅文献并进行荟萃分析。
根据上皮表现类型将患者分为5组。8例患者病变位于远离视轴的界面内。1例患者视轴界面内有内生，2例有角膜后受累，1例有前房受累。1例既有角膜后又有前房受累。8例患者进行了排气切口，但仅1例内生与排气切口有关。9例患者经观察无明显进展迹象。4例患者接受手术治疗以清除上皮。
上皮内生或植入最常见于远离视轴的界面内，通常无进展。呈现均匀的灰白色界面混浊是其特征。排气切口可导致内生，但很少见。其他原因包括偏心植床、供体或受体上皮在手术时被拖入眼内。
