Background: We report a case in which non-infectious corneal opacity was observed in a corneal graft during the initial recovery period after penetrating keratoplasty (PKP). We report a rare case of fibrosis in a corneal graft soon after PKP surgery.
Case: The patient was a 62-year-old woman. In August 2014, she was referred to Hiroshima University Hospital for the treatment of keratoconus in both eyes. Because her condition was difficult to correct with rigid gas-permeable contact lenses owing to the abnormal corneal shape, PKP was performed for the left eye in June 2015 with a good clinical course. In October 2016, PKP was performed on the right eye as well. Corneal stromal edema occurred 1 week after the surgery. The corneal opacity subsequently expanded toward the central area of the graft and was focused around the endothelium. In June 2017, PKP was re-performed for the right eye. The histopathological findings of the graft obtained at the time of reoperation showed that tissue containing myofibroblasts was present on the corneal endothelium and in the corneal parenchyma, which coincided with the cloudy areas of the explanted cornea. No recurrence of corneal opacity was observed after the second PKP, and the patient progressed well.
Conclusion: There is a possibility that fibrosis progression occurred in the corneal graft at an early phase after PKP either due to the transformation of the stromal cells into myofibroblasts or due to the endothelial-mesenchymal transition of the stromal cells or endothelial cells.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 533-539,2022.