In vivo confocal microscopy of subepithelial infiltrates in human corneal transplant rejection.

PURPOSE: Corneal allograft rejection is the leading cause of penetrating keratoplasty failure in the first year after surgery. We report 2 cases of subepithelial infiltrates in corneal transplant rejection imaged by in vivo confocal microscopy.

METHODS

Case report and review of relevant literature.

RESULTS

Two subjects with subepithelial infiltrates in previously clear penetrating corneal transplants were assessed. In vivo confocal microscopy revealed focal accumulations of hyperreflective dendritic-like particles, postulated to represent Langerhans cells, at the level of the basal epithelium and Bowman membrane. Altered keratocytes with visible cytoplasmic processes were observed posterior to these foci.

CONCLUSIONS

To our knowledge, these are the first reported cases of in vivo confocal microscopy appearance of corneal allograft rejection in humans. In vivo confocal microscopy may provide a valuable clinical tool to aid in the diagnosis of early corneal transplant rejection and in the differential diagnosis of other inflammatory conditions of the cornea.