Acquired Corneal Subepithelial Hypertrophy: First Ultrastructural Characterization by Transmission Electron Microscopy.
Matilde Buzzi, Mirko Manetti, Alfonso Strianese et al.
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Case in brief
A 57-year-old man with prior penetrating keratoplasty for trauma and subsequent Descemet stripping automated endothelial keratoplasty developed progressive visual decline from a superficial corneal opacity. Imaging localized the lesion to the subepithelial compartment. Selective peeling restored best-corrected visual acuity, with no recurrence at 1-year follow-up. Histology showed irregular epithelial thickening, absent Bowman layer, and subepithelial fibrosis with myofibroblasts, without inflammation or neovascularization. Transmission electron microscopy demonstrated epithelial mitochondrial damage with mitophagy, disrupted intercellular junctions, and myofibroblasts with abundant rough endoplasmic reticulum, consistent with active fibrotic remodeling.
What made this case unusual
The report provides detailed transmission electron microscopy of acquired corneal subepithelial hypertrophy, showing mitochondrial damage and mitophagy in epithelium alongside ultrastructural features of active subepithelial fibrosis.
Diagnostic / clinical pearl
When a superficial opacity causes progressive visual decline, multimodal anterior-segment assessment can localize it to the subepithelial compartment; tissue examination may distinguish acquired corneal fibrosis from other corneal degenerations.