DOI: 10.4103/dljo.dljo_35_26 ISSN: 0972-0200

Beyond the Button: Clinicopathological Insights from Histopathological Evaluation of the Host Cornea after Penetrating Keratoplasty

Akanksha Agrawal, Siddharth Madan, Avani Hariani, Rekha Yadav, Nadeem Tanveer, Jolly Rohatgi, Pramod Kumar Sahu
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Abstract

Purpose:

The purpose of this study was to evaluate histopathological findings of corneal buttons following penetrating keratoplasty (PKP), assess clinicopathological correlation, and identify discrepancies influencing postoperative management.

Materials and Methods:

This observational study was conducted at a tertiary eye care centre in Delhi over 4 months. Twenty consecutive cases undergoing full-thickness PKP were included. All excised corneal buttons were subjected to routine histopathological examination. Special stains were performed when indicated. Clinical diagnosis was compared with histopathological findings, and discrepancies were analyzed.

Results:

Twenty eyes (8 males, 12 females; mean age 42 years) underwent PKP. The most common indication was leukomatous corneal opacity (LCO) in 60% of patients ( n = 12/20), of which 10 (83.33%) patients developed LCO postinfection, and 2 patients had an opacity following trauma, accounting for 16.66%. Other indications included bullous keratopathy (25%), infective keratitis requiring therapeutic keratoplasty (10%), and corneal dystrophy (5%). Clinicopathological concordance was observed in 18 (90%) cases. In one case, clinically healed corneal opacity showed persistent stromal inflammation on histopathology, leading to modification of postoperative steroid therapy. Another case clinically suspected to be Acanthamoeba keratitis showed only acute inflammation and no protozoal cysts.

Conclusion:

Histopathological examination provides valuable confirmation of clinical diagnosis, detection of occult disease activity, typing of infective keratitis as bacterial or fungal through specific morphology and special stains, and also guides postoperative management. Routine submission of corneal buttons for histopathological evaluation is recommended to improve patient outcomes and document regional trends in indications for keratoplasty.

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