Epithelial downgrowth after cataract surgery: an atypical presentation with scleral thinning and massive seeding in anterior chamber

To report an atypical presentation of epithelial downgrowth (ED) after clear cornea cataract extraction, characterized by mixed clinical expression of both cystic and diffuse form and massive epithelial debris seeding in anterior chamber, associated with scleral involvement.

In this case report, fine needle anterior chamber aspiration cytology was performed to identify pathologic tissue invading iris, cornea, and angular structures. The patient was treated with anterior chamber membrane surgical excision.

Epithelial downgrowth was identified by cytologic assessment. The patient was treated with epithelial membrane peeling and scleral defect conjunctival covering. This conservative surgical approach led to a significant reduction of ocular pain. During follow-up, residual epithelial tissue was present in anterior chamber without tendency to regrowth.

In doubtful cases of ED, histocytopathologic analysis should be performed without hesitation. Avoiding more invasive procedures, early detection and prompt surgical approach can result in improved outcome even in case of extensive intraocular involvement.