Subepithelial Fibrosis After Myopic Epikeratoplasty

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Abstract
• A 29-year-old man with a −22.00diopter myopia in the right eye underwent a planar, nonfreeze myopic epikeratoplasty and postoperatively developed a central subepithelial opacity. The opacity recurred after two superficial keratectomies; finally, another epikeratoplasty was performed. Light microscopic examination of the original button showed that the epithelium was thickened, collagenous subepithelial fibrocellular tissue was present, and Bowman's layer was focally disrupted. The stroma was edematous and peripherally scarred with scattered keratocytes. Examination by transmission electron microscopy revealed keratocytes lying anterior and posterior to Bowman's layer. The subepithelial fibrocellular tissue corresponded to an area of a break in Bowman's layer and probably originated from the donor stroma. The break in Bowman's layer may have been caused by the microkeratome cuts, but its origin is not certain.