Transcript Ocular Pathology Case Presentation

Ocular Pathology Case
Presentation
Kristin Rarey, M.D.
February 2010
Case Presentation
• 32 y/o M s/p OD PKP
• Clinical history unknown, preliminary diagnosis
unspecified
• H&E slides:
– Mild bullous keratopathy
– Centrally there is duplication of Bowman’s layer with
healthy-appearing stroma intervening
– Peripherally there is some epithelial down growth and
irregularity of the stroma
– Endothelium intact without evidence of guttae
Case # PHS10-1980
Magnified view showing double
bowman’s membrane
Clinical History
• Patient presented to UPMC Eye Center in
2005 for a second opinion regarding his
high and irregular astigmatism
• Per the patient, he had surgery bilaterally
for “masses” on his corneas at age 6 years
– Clinically, evidence of previous bilateral
epikeratophakia
• Patient using rigid gas permeable contact
lenses at presentation
Myopic Degeneration OU
•
OD - The disc is surrounded by peripapillary atrophy. There are
central pigment changes. The fundus is tigroid in appearance.
Pentacam study demonstrates highly irregular corneal profiles bilaterally after
LK. There is temporal thickening resulting in a nearly 30D difference in height
between the temporal and nasal parts of the cornea in each eye.
Visante Anterior OCT
Showing the irregular corneal curvature of the right eye
Surgical History
• 1983
– Bilateral Lamellar Keratoplasties (epikeratophakia)
• 10/29/2008
– Astigmatic Keratotomy OD: incisions made at the
steep axis of astigmatism to induce corneal flattening
• 1/19/2010
– Penetrating Keratoplasty OD
PKP Histology
• Corneal button removed entirely and
replaced with a button of donor cornea
• Variable findings depending on the
indication for transplant
– Bullous keratopathy
– Corneal scarring
– Keratinization
– Corneal thinning
Epikeratophakia Histology
•
•
Epithelium removed from patient and replaced with epithelium-Bowman’sstroma from a donor (epikeratophakia)
2 Bowman’s layers observed: deeper Bowman’s is patient’s native tissue,
more superficial Bowmans is donor tissue (along with epithelium and
stroma)
Final Diagnosis
• Pathology slides PHS10-1980 are consistent
with previous epikeratophakia (transplantation of
donor epithelium/Bowman’s/stroma).
• Keratoconus is the most common indication for
epikeratophakia
– This is an attractive procedure because, unlike conventional, fullthickness transplants, it is 1)reversible and 2) associated with a low
incidence of graft rejection as the endothelium is not transplanted
– Alternative procedures include full thickness PKP, Deep Anterior
Lamellar Keratoplasty (DALK), use of rigid gas permeable contact
lenses in patients who can tolerate them, or placement of INTACS
within the corneal stroma