Healed corneal ulcer with keloid formation

Abstract

We are reporting a 34-year-old Arabic white female patient who presented with a white mass covering her left cornea following multiple ocular surgeries and healed corneal ulcer. The lesion obscured further view of the iris, pupil and lens. The patient underwent penetrating keratoplasty and the histopathologic study of the left corneal button showed epithelial hyperplasia, absent Bowman's layer and subepithelial fibrovascular proliferation. The histopathologic appearance was suggestive of a corneal keloid which was supported by further ultrastructural study. The corneal graft remained clear 6 months after surgery and the patient was satisfied with the visual outcome. Penetrating keratoplasty may be an effective surgical option for corneal keloids in young adult patients.

Keywords: Corneal mass; Histopathology; Keloid; Penetrating keratoplasty.

Figure 1

(a) The clinical appearance of the whitish lesion covering most of the left cornea. (b) Side view of the left corneal keloid. (c) Slitlamp photography showing clear corneal graft with no recurrence 6 months after surgery. (d) The post-operative clinical appearance showing peaked pupil secondary to peripheral anterior synechiae at 2 o’clock.

Figure 2

(a) Stromal neovascularization at the base of the lesion (periodic acid schiff, original magnification × 100). (b) Vimentin stain showing reactive fibroblasts (original magnification × 100).

Figure 3

(a) Electron Micrograph of mature myofibroblasts (original magnification × 4900). (b) Electron Micrograph of myofibroblast showing numerous thin filaments and fusiform densities (original magnification × 24,000). (c) Electron Micrograph of inactive fibrocyte (original magnification × 3300). (d) Electron Micrograph of fibroblast with fibrillar cytoplasm (original magnification × 18,500).