Development of epithelial downgrowth several decades after intraocular surgery

Purpose: To report the management of a patient with the longest reported interval between intraocular surgery and the development of epithelial downgrowth. Methods: A 53-year-old man who underwent right eye penetrating keratoplasty in 1970 for keratoconus and removal of an iris cyst in 1977 developed epithelial downgrowth 25 years after cyst removal. Results: The area of epithelial downgrowth was initially treated with cryotherapy. Two weeks postoperatively, the patient had no resolution of epithelial downgrowth and developed diffuse corneal edema. Penetrating keratoplasty was performed along with extracapsular cataract extraction. At 6 months of follow-up, the patient's graft was clear, without evidence of recurrence of epithelial downgrowth, and he had 20/50 visual acuity. Conclusion: Epithelial downgrowth is an uncommon yet serious complication of intraocular surgery, making early detection of this condition important. This case illustrates that epithelial downgrowth can occur several decades after intraocular surgery.