Subclinical Epithelial Basement Membrane Dystrophy Presenting as Recurrent Corneal Erosion after Descemet Stripping Automated Endothelial Keratoplasty: A Case Report

Abstract

In surgeries involving epithelial debridement, prompt epithelial healing is essential for optimal postoperative outcomes. We report the case of a 70-year-old lady who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) with intraoperative epithelial debridement for pseudophakic bullous keratopathy in her left eye. Despite a well-attached DSAEK graft, she experienced delayed epithelial healing and multiple episodes of recurrent corneal erosion in the postoperative period. Evaluation with anterior segment optical coherence tomography of her clinically normal right eye showed hyper-reflective dots in the corneal epithelium and irregular epithelial thickening, indicating subclinical epithelial basement membrane dystrophy as a probable contributing factor. The patient was managed conservatively with bandage contact lens, lubricants, and hypertonic saline eye ointment. Our case demonstrates that underlying subtle epithelial and basement membrane abnormalities may compromise epithelial healing following procedures involving epithelial debridement.