Epithelial Downgrowth Mixed With Fibrous Ingrowth After Complicated Cataract Surgery: A Challenging Clinical Case

Epithelial downgrowth (ED) is a rare but dreaded complication of intraocular surgery or trauma and is characterized by the intraocular migration or seeding of epithelial cells from the ocular surface, sometimes with concurrent intraocular proliferation of fibrovascular tissue. Due to its insidious development, it may present diagnostic difficulties to the ophthalmologist; moreover, its relentless progression poses a tough therapeutic challenge with a generally poor visual prognosis. In this paper, we describe the case of a 68-year-old man who developed mixed ED and fibrous ingrowth (FI) after complicated cataract surgery. His clinical picture was initially misdiagnosed and treated as malignant glaucoma with only a brief period of improvement. Surgical removal of a specimen of the pathologic intraocular tissue, followed by its cytological analysis, confirmed the diagnosis. Due to intractably high intraocular pressure (IOP) and persistent corneal edema, we proceeded to glaucoma shunt implantation and subsequently to full-thickness corneal transplantation. Eighteen months after the keratoplasty, the patient fares well with a reasonably good vision of 20/30, a clear corneal graft, and no signs of downgrowth recurrence. This case illustrates the diagnostic and therapeutic challenges posed by ED but also the importance of its multidisciplinary management in order to achieve the best possible visual outcome for the patient.