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Published on: December 2, 2022
Clinical Outcomes After Weekly Intracameral Melphalan Administration for Epithelial Downgrowth
Geraldine Zi Yi Lee1,2, Ljubica Bukorovic3, Ashley J Porter4,5,6
1Department of Ophthalmology, Mater Hospital, South Brisbane, Queensland, Australia.
Cornea
|June 23, 2026
Summary
Intracameral melphalan shows promise in treating epithelial downgrowth, with most cases showing no recurrence. However, careful monitoring for side effects like elevated intraocular pressure is crucial.
Area of Science:
- Ophthalmology
- Medical Treatments
Background:
- Epithelial downgrowth is a rare but serious complication following intraocular surgery or trauma.
- Current treatment options for epithelial downgrowth are limited and often invasive.
Purpose of the Study:
- To evaluate the efficacy and safety of intracameral melphalan as an adjunctive therapy for epithelial downgrowth.
- To assess recurrence rates, visual outcomes, and adverse effects associated with intracameral melphalan treatment.
Main Methods:
- Retrospective, noncomparative interventional case series involving 4 patients.
- Primary outcome: resolution of epithelial downgrowth.
- Secondary outcomes: best-corrected visual acuity (BCVA), intraocular pressure (IOP), recurrence, adverse events, and need for corneal grafting.
Main Results:
- No recurrence of epithelial downgrowth in 3 out of 4 cases within 3 years post-treatment.
- One case recurred at 42 months, potentially due to a separate event.
- Most patients maintained or improved BCVA; however, all required management for elevated IOP, and 3 needed repeat corneal grafts.
Conclusions:
- Intracameral melphalan presents a viable alternative for managing epithelial downgrowth.
- Potential adverse effects include elevated IOP, corneal decompensation, and retinal toxicity, necessitating vigilant monitoring, especially in unicameral eyes.
- Standardized future research with gonioscopy and endothelial cell monitoring is recommended.