[Block excision of epithelial ingrowth after cataract surgery--report on 15 patients]

Cystic or diffuse epithelial ingrowth into the anterior chamber after cataract surgery is a rare complication. It can lead to painful secondary glaucomas or in case of fistulation to persisting ocular hypotony or atrophy of the globe due to wrong or inadequate therapy.

The cause of epithelial ingrowth was a previous cataract surgery in 15 of 59 patients (25 %, Erlangen Block-Excision Registry for epithelial ingrowth). Eleven patients were females. Mean age was 65 +/- 13 years.

Ten patients underwent block excision of epithelium, adjacent iris, ciliary body, sclera or cornea due to epithelial ingrowth following intracapsular cataract extraction between 1980 and 1987 and five patients since 1987 because of epithelial ingrowth following extracapsular cataract extraction (4 with and 1 without intraocular lens implantation); all primary cataract surgeries had been performed in external hospitals. We found a diffuse invasion in 3 eyes (all following icCE) and a cystic epithelial invasion in 12 eyes histologically. Mean time interval between cataract surgery and block excision was 7 +/- 8 years (range: 1 to 33 years). The excisional defect in the globes wall was covered using a tectonic corneoscleral graft (diameter: 8.0 +/- 1.8 mm). Postoperative astigmatism was 3.6 +/- 3.4 dpt. Six eyes had postoperatively a visual acuity of 20/200 or better. No recurrence of epithelial downgrowth was observed, nor was an enucleation needed.

Surgical procedures with opening of the cyst (e.g. laser) are contraindicated and may lead to a transformation from cystic into diffuse epithelial invasion with potential blindness. The therapy of first choice in eyes with cystic epithelial ingrowth and an extension less than five clock hours is the curative block-excision technique combined with tectonic corneoscleral graft. Surgical results are excellent in order to regard a curative excision and the survival of the eye with acceptable achieved function in consideration of the difficult primary situation with intra- and postoperative complications due to previous cataract surgery.