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Presentation type	Oral presentation
Title	Unusual occurrence of graft-host interface epithelial ingrowth imitating infection following DMEK surgery

Purpose	To report our experience of interface epithelial ingrowth post-Descemet membrane endothelial keratoplasty (DMEK) surgery.
Methods	Patient was examined, diagnosed and treated by the corneal team in the Ophthalmology Department at University Hospitals of Leicester, a tertiary care hospital.
Results	An 81-year-old female with Fuchs’ endothelial dystrophy, cataract and dry age-related macular degeneration underwent uncomplicated left triple DMEK surgery. Pre-operative left distance visual acuity was 0.50 LogMAR. At 7 weeks post-operatively, multiple left graft-host interface opacities were noted and suspected to be of infectious origin. An emergency anterior chamber tap was performed for microbiology culture, and intra-cameral Voriconazole and Cefuroxime were injected. The patient was started on topical levofloxacin 0.5% and voriconazole 1% hourly. Topical dexamethasone 0.1% was stopped. AS-OCT showed hyperreflective interface deposits corresponding to the opacities. Aqueous tap cultures were negative. Topical antimicrobial treatment was tapered and discontinued, and topical steroids were recommenced. The clinical diagnosis of epithelial ingrowth was made and confirmed by in vivo confocal microscopy (IVCM). Despite progression, the patient remained asymptomatic with a visual acuity of 0.28 LogMAR 15.5 months post-operative.
Conclusion	Epithelial ingrowth is a fairly unknown complication after DMEK surgery which can mimic an insidious infectious keratitis. Appropriate investigation and treatment are required, and IVCM may serve as a useful diagnostic modality in achieving the correct diagnosis.
Conflict of interest	No

Authors 1

Last name	HOUBEN
Initials	I
Department	University Hospitals of Leicester NHS Trust
City	Leicester

Authors 2

Last name	Dhillon
Initials	N
Department	University Hospitals of Leicester NHS Trust
City	Leicester

Authors 3

Last name	Darren
Initials	T
Department	Queen's Medical Centre
City	Nottingham

Authors 4

Last name	Harminder
Initials	D
Department	Queen's Medical Centre
City	Nottingham