case_images: PMC11796081_01
case_images: A The central area of the corneal graft was conical and slightly thinned, with the apex located slightly temporal to the center. B Severe anterior protrusion and stromal scarring, resulting in an inability to obtain images. C The central cornea was thinned and anteriorly protruded, with stromal opacity located in the superficial stroma. D The distribution of anterior stromal cells was uneven, with some activated cells exhibiting nuclear fusion and connection. The dark areas may represent sites of stromal lamellar disruption. E Best-corrected visual acuity after the second DALK is 20/33 (+ 2.00DC x 75)
case_images: 12886_2025_3877_Fig1_HTML.jpg
case_images: PMC11796081_01_12886_2025_3877_Fig1_HTML.jpg
case_images: Fig1
case_images: A grayish-white superficial stromal scar measuring approximately 1 x 2 mm was visible at the apex, and a Fleischer ring measuring approximately 3 x 4.5 mm was present (Fig. 1A). The left eye had high irregular astigmatism (Fig. 1B), and anterior segment optical coherence tomography (OCT) showed that the opacity was located in the superficial stroma (Fig. 1C). Confocal microscopy of the anterior stroma showed uneven distribution of stromal cells (Fig. 1D). DALK was performed again. During surgery, the graft was bluntly separated along the original graft-host junction and sutured with a graft of equal size to the host bed (Fig. 1E).
case_images: A A horizontal grey-white stromal scar measuring approximately 0.5 x 2.5 mm was seen at the top of the cone, along with a Fleischer ring measuring approximately 4 x 5 mm. B Moderate congestion was observed in the palpebral conjunctiva of the upper eyelid, with numerous papillary projections present. C The cornea exhibited high irregular astigmatism, with a maximum corneal curvature of 83.95D. D The stromal cell structure in the superficial stroma was disorganized and in an activated state. E The central area of the corneal graft exhibited stromal thinning and anterior protrusion
case_images: 12886_2025_3877_Fig2_HTML.jpg
case_images: PMC11796081_01_12886_2025_3877_Fig2_HTML.jpg
case_images: Fig2
case_images: Examination revealed that the central area of the left corneal graft was conical and convex, with slight thinning (Fig. 2A). Upon everting the upper eyelid, moderate congestion was observed, and the palpebral conjunctiva had numerous papillary projections (Fig. 2B). At this visit, corneal topography, confocal microscopy, anterior segment OCT, and histology of tissue were performed to assist in diagnosis (Fig. 2C - E).