Epithelial downgrowth

Epithelial downgrowth is a disastrous complication of ocular surgery or trauma in which corneal or conjunctival epithelium invades the anterior chamber and other intraocular structures. The epithelial growth patterns are categorized as diffuse or cystic growth, with diffuse growth being up to four times more common and occurring more frequently after trauma. The current incidence of epithelial downgrowth is difficult to determine. Previous literature has cited cataract surgery as the most common cause with an incidence of 0% to 0.076% and up to 1.1%. Most authors agree the incidence of epithelial downgrowth has decreased secondary to improvements in surgical technique, instrumentation, and suture material. Other surgical procedures cited as predisposing to epithelial downgrowth are listed in Table 74.1. The time to onset is highly variable and dependent on etiology. For example, epithelial downgrowth following cataract surgery has been reported 4 days to 56 years into the postoperative period, with a mean onset of presentation ranging from 5 months to 10 months. In one study, epithelial downgrowth occurred 4-7 months following penetrating keratoplasty. Glaucoma is variably present in patients with epithelial downgrowth. In Küchle and Green's review of 207 histopathologically proven cases, they reported a rate of glaucoma of 43.1%.