case_images: PMC4464587_01
case_images: (a) Slit lamp photograph of the right eye showing epithelial downgrowth (EDG) involving the nasal aspect of the patient's graft (border indicated by arrows) and extending onto the superonasal native corneal endothelium. (b) Anterior chamber fluid aspirate with endothelial scraping shows the clump of squamous cells that made the diagnosis of EDG. (c) Periphery of penetrating keratoplasty specimen showing thin layer of surface epithelium (single arrow) on posterior surface of DSAEK graft. Epithelium has extended onto anterior surface of graft at left. (d) Margin of surface epithelial sheet on posterior surface of DSAEK graft. (e) Corneal epithelium and EDG on posterior cornea show similar intense immunoreactivity for cytokeratin marker AE1/AE3. (b) H&E x400, (c) H&E x25, (d) H&E x250, and (e) IHC for AE1/AE3, x50.
case_images: CRIOPM2015-325485.001.jpg
case_images: PMC4464587_01_CRIOPM2015-325485.001.jpg
case_images: fig1
case_images: Slit lamp examination revealed a scalloped border of apparent EDG involving the nasal 20% of the graft, extending onto the superonasal native corneal endothelial surface (Figure 1). Cytology performed on an anterior chamber fluid aspirate with endothelial scrapings established the diagnosis of EDG (Figure 1). Intense immunoreactivity for cytokeratin marker AE1/AE3 confirmed the diagnosis (Figure 1).
case_images: PMC4464587_02
case_images: (a) Slit lamp photograph of the right eye showing epithelial downgrowth (EDG) involving the temporal aspect of the cornea (border indicated by arrow). (b) Four months after the 5FU injections, there was no clinical evidence of EDG, but there was significant corneal edema secondary to endothelial decompensation. (c) DSAEK specimen showing rare epithelial cells on the posterior surface of host cornea. (d) EDG on the posterior surface of a portion of the DSAEK graft shows immunoreactivity for cytokeratin marker AE1/AE3. (c) H&E x50, (d) IHC for AE1/AE3, x250.
case_images: CRIOPM2015-325485.002.jpg
case_images: PMC4464587_02_CRIOPM2015-325485.002.jpg
case_images: fig2
case_images: Eighteen months after the initial surgery, his best corrected visual acuity was 20/40, but intraocular pressure (IOP) fluctuated up to 49 mmHg, and slit lamp examination revealed an area of apparent EDG involving 50% of the temporal cornea, with extensive anterior chamber angle closure (Figure 2). Histopathologic analysis of the host specimen demonstrated rare epithelial cells that exhibited immunoreactivity for cytokeratin marker AE1/AE3, consistent with residual EDG (Figure 2).