Subepithelial Complications

Abstract

In 1978 Krachmer and Alldredge first described subepithelial infiltrations as a form of immune reaction [3]. These are delicate round infiltrations, level with Bowman’s membrane, appearing on the non irritated eye (Fig. 3.1, pg. 35 and 3.2, pg. 35). They are limited to the transplant, with irregular distribution. Combinations with other immune reactions are possible (Fig. 3.3, pg. 36). Compared with epithelial immune reactions, subepithelial reactions appear late. They can appear twelve months or later following surgery. They are not uncommonly discovered by chance, for example with late suture removal. Relatively early onsets can be seen with second keratoplasty [6]. According to literature, the incidence of subepithelial infiltrations is in the range between 2.4% and 15% [1, 2, 5, 6]. Nummular like focuses can appear relatively late [1, 7], i.e. at a time when patients are no longer subject to regular ophthalmologic follow-up examinations. Despite an immunological reaction the eye shows no irritation. If the deeper layers are not involved, there is usually no damage.