Epithelial ingrowth in the flap-graft interface after microkeratome-assisted posterior penetrating keratoplasty.

A 79-year-old woman with pseudophakic bullous keratopathy had microkeratome-assisted posterior keratoplasty for the treatment of clinically significant corneal edema. An island of epithelial ingrowth was noted in the flap-graft interface that was not communicating with the flap periphery. Partial lifting of the anterior corneal flap and removal and irrigation of the epithelial cells were successfully performed. A review of reports of microkeratome-assisted posterior penetrating keratoplasty shows epithelial ingrowth is common after this procedure. The presence of posterior sutures, a central location of the epithelial cells, communication with the periphery, and evidence of stromal melting should prompt immediate surgical intervention.