Epithelial downgrowth--fistula repair and keratoplasty

Eight patients with leaking fistulas from epithelial downgrowth were repaired by various techniques. Wide excision of the fistula and replacement with a graft, followed by a conjunctival flap, proved to be the most satisfactory technique for dealing with the fistula. However, this subset of patients responded to fistula closure with a much worse secondary glaucoma than downgrowth patients in general. Fifteen patients with proven epithelial down-growth received penetrating keratoplasty. Eleven of these grafts failed within a year, but there was no regrowth of epithelium on the back of the graft in at least two patients. In spite of generally discouraging results, we recommend immediate closure of epithelialized fistula to avoid even more severe complications in the future. We also recommend keratoplasty, repeated if necessary, in severe corneal edema. Both situations may eventually require radical glaucoma surgery and/or keratoprosthesis.