Clinical Outcomes After Weekly Intracameral Melphalan Administration for Epithelial Downgrowth

To explore if intracameral melphalan can be used as an adjunct treatment for epithelial downgrowth.

This was a retrospective, noncomparative interventional case series. The main outcome measure was the resolution of epithelial downgrowth. Secondary measures of interest included best-corrected visual acuity (BCVA) and intraocular pressure (IOP), along with epithelial downgrowth recurrence, adverse effects, and need for repeat corneal grafts.

All 4 cases did not experience epithelial downgrowth recurrence after melphalan administration in the subsequent 3 years. One case developed a recurrence at 42 months after melphalan administration, thought to be because of a separate inciting event. The BCVA was stable or improved at the last follow-up appointment for most cases. All cases required management for elevated IOP. Three cases required repeat corneal grafting for corneal decompensation.

Intracameral melphalan is a viable alternative in the management of epithelial downgrowth. However, clinicians using melphalan must monitor for potential adverse effects including elevated IOP, corneal decompensation, and retinal toxicity, particularly in unicameral eyes. Future studies into melphalan or other adjunct medical treatments should involve a standardized approach with gonioscopy and endothelial cell count monitoring.