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Ophthalmic Images

In-vivo and ex-vivo analysis of an unusual case of huge bullous keratopathy

Giannaccare, Giuseppe; Lucisano, Andrea; Scorcia, Vincenzo

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Indian Journal of Ophthalmology: November 2020 - Volume 68 - Issue 11 - p 2524
doi: 10.4103/ijo.IJO_1085_20
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A 72-year-old woman presented with painful corneal edema in an eye blinded by angle-closure glaucoma. Slit-lamp examination showed the anterior corneal surface protruding through the palpebral fissure (A-B) [Fig. 1]. Anterior segment optical coherence tomography (AS-OCT) revealed the presence of an unusual huge epithelial bulla delimiting two virtual spaces (”clefts”) (C). The bullous lesion was surgically removed and Gundersen conjunctival flap was used to resurface the underlying fibrous pannus.[1] Histologically, the two clefts originated from the splitting of the corneal epithelium (D).

Figure 1
Figure 1:
Slit lamp examination showed a huge epithelial bulla of the cornea protruding through the palpebral fissure (a and b). Anterior segment OCT revealed two “clefts” that originated from the splitting of the corneal epithelium, as confirmed by histopathology (c and d)

This unique case highlights the importance of AS-OCT for surgical planning and histopathology for a definitive diagnosis.

2.1 Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

2.2 Financial support and sponsorship


2.3 Conflicts of interest

There are no conflicts of interest.


The authors would like to thank the Veneto Eye Bank Foundation (Venice, Italy) for conducting the histological analysis of the specimen.


. Conjunctival flaps in the treatment of corneal disease with reference to a new technique of application AMA Arch Ophthalmol. 1958;60:880–8
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