Epithelial Downgrowth

  • Matthew C. Willett
  • Sami Al-Shahwan
  • Deepak P. Edward


Epithelial downgrowth is a disastrous complication of ocular surgery or trauma in which corneal or conjunctival epithelium invades the anterior chamber and other intraocular structures. The epithelial growth patterns are categorized as diffuse or cystic growth, with diffuse growth being up to four times more common and occurring more frequently after trauma. The current incidence of epithelial downgrowth is difficult to determine. Previous literature has cited cataract surgery as the most common cause with an incidence of 0% to 0.076% and up to 1.1%. Most authors agree the incidence of epithelial downgrowth has decreased secondary to improvements in surgical technique, instrumentation, and suture material. Other surgical procedures cited as predisposing to epithelial downgrowth are listed in Table 74.1. The time to onset is highly variable and dependent on etiology. For example, epithelial downgrowth following cataract surgery has been reported 4 days to 56 years into the postoperative period, with a mean onset of presentation ranging from 5 months to 10 months. In one study, epithelial downgrowth occurred 4-7 months following penetrating keratoplasty. Glaucoma is variably present in patients with epithelial downgrowth. In Küchle and Green’s review of 207 histopathologically proven cases, they reported a rate of glaucoma of 43.1%.


Anterior Chamber Goblet Cell Diffuse Growth Conjunctival Epithelium Postoperative Visual Acuity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Küchle M, Green WR. Epithelial ingrowth: a study of 207 histopathologically proven cases. Ger J Ophthalmol. 1996;5(4):211–223.PubMedGoogle Scholar
  2. 2.
    Weiner MJ, Trentacoste J, Pon DM, Albert DM. Epithelial downgrowth: a 30-year clinicopathological review. Br J Ophthalmol. 1989;73:6–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Maumenee AE, Paton D, Morse PH, Butner R. Review of 40 histologically proven cases of epithelial downgrowth following cataract extraction and suggested surgical management. Am J Ophthalmol. 1970;69(4):598–603.PubMedGoogle Scholar
  4. 4.
    Peyman GA, Peralta E, Ganiban GJ, Kraut R. Endoresection of the iris and ciliary body in epithelial downgrowth. J Cataract Refract Surg. 1998;24(1):130–133.PubMedGoogle Scholar
  5. 5.
    Smith MF, Doyle JW. Glaucoma secondary to epithelial and fibrous downgrowth. Semin Ophthalmol. 1994;9(4):248–253.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee BL, Gaton DD, Weinreb RN. Epithelial downgrowth following phacoemulsification through a clear cornea. Arch Ophthalmol. 1999;117:283.PubMedGoogle Scholar
  7. 7.
    Walker BM, Hindman HB, Ebrahimi KB, et al. Epithelial downgrowth following Descemet’s-stripping automated endothelial keratoplasty. Arch Ophthalmol. 2008;126(2):278–280.CrossRefPubMedGoogle Scholar
  8. 8.
    Zavala EY, Binder PS. The pathologic findings of epithelial ingrowth. Arch Ophthalmol. 1980;98(11):2007–2014.PubMedGoogle Scholar
  9. 9.
    Jewelewicz DA. Epithelial downgrowth following insertion of an Ahmed glaucoma implant. Arch Ophthalmol. 2003;121(2):285–286.PubMedGoogle Scholar
  10. 10.
    Giaconi JA, Coleman AL, Aldave AJ. Epithelial downgrowth following surgery for congenital glaucoma. Am J Ophthalmol. 2004;138(6):1075–1077.CrossRefPubMedGoogle Scholar
  11. 11.
    Feder RS, Krachmer JH. The diagnosis of epithelial downgrowth after keratoplasty. Am J Ophthalmol. 1985;99:697–703.PubMedGoogle Scholar
  12. 12.
    Naumann GOH, Rummelt V. Block excision of cystic and diffuse epithelial ingrowth of the anterior chamber. Report on 32 consecutive patients. Arch Ophthalmol. 1992;110:223–227.PubMedGoogle Scholar
  13. 13.
    Fish LA, Heuer DK, Baerveldt G, et al. Molteno implantation for secondary glaucoma associated with advanced epithelial ingrowth. Ophthalmology. 1990;97:557–561.PubMedGoogle Scholar
  14. 14.
    Smith RE, Parrett C. Specular microscopy of epithelial downgrowth. Arch Ophthalmol. 1978;96(7):1222–1224.PubMedGoogle Scholar
  15. 15.
    Chee PH. Epithelial downgrowth. Arch Ophthalmol. 1967;78(4): 492–495.PubMedGoogle Scholar
  16. 16.
    Rubin B, Chan CC, Burnier M, et al. Histopathologic study of the Molteno glaucoma implant in three patients. Am J Ophthalmol. 1990;110:371–379.PubMedGoogle Scholar
  17. 17.
    Kuchle M, Naumann GOH. Mucogenic secondary open-angle glaucoma in diffuse epithelial ingrowth treated by block-excision. Am J Ophthalmol. 1991;111:230–234.PubMedGoogle Scholar
  18. 18.
    Holliday JN, Buller CR, Bourne WM. Specular microscopy and fluorophotometry in the diagnosis of epithelial downgrowth after sutureless cataract operation. Am J Ophthalmol. 1993;116: 238–240.PubMedGoogle Scholar
  19. 19.
    Green WR. Diagnostic cytopathology of ocular fluid specimens. Ophthalmology. 1984;91:726–749.PubMedGoogle Scholar
  20. 20.
    Engel HM, Green WR, Michaels RG, et al. Diagnostic vitrectomy. Retina. 1981;1:121–129.CrossRefPubMedGoogle Scholar
  21. 21.
    Burris TE, Nordquist RE, Rowsey JJ. Long-term evaluation of epithelial downgrowth models. Cornea. 1986;5:211–221.CrossRefGoogle Scholar
  22. 22.
    Stark WJ, Michaels RG, Maumenee AE, et al. Surgical Management of epithelial ingrowth. Am J Ophthalmol. 1978;85:772–780.PubMedGoogle Scholar
  23. 23.
    Friedman AH. Radical anterior segment surgery for epithelial invasion of the anterior chamber: report of three cases. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977;83(2):216–223.PubMedGoogle Scholar
  24. 24.
    Haller JA, Stark WJ, Azab A, Thomsen RW, Gottsch JD. Surgical approaches to the management of epithelial cysts. Trans Am Ophthalmol Soc. 2002;100:79–84.PubMedGoogle Scholar
  25. 25.
    Taylor HR, Michaels RG, Stark WJ. Vitrectomy methods in anterior segment surgery. Ophthalmic Surg. 1979;10:25–58.PubMedGoogle Scholar
  26. 26.
    Jadav DS, Rylander NR, Vold SD, Fulcher SF, Rosa RH Jr. Endoscopic photocoagulation in the management of epithelial downgrowth. Cornea. 2008;27(5):601–604.CrossRefPubMedGoogle Scholar
  27. 27.
    Maumenee AE. Treatment of epithelial downgrowth and intraocular fistula following cataract extractions. Trans Am Opthalmol Soc. 1964;62:153.Google Scholar
  28. 28.
    Bangert A, Bialasiewicz AA, Engelmann K, Schäfer HJ, Domarus DV. Intraocular epithelial downgrowth - report on 14 cases from 1986 to 2000. Klin Monatsbl Augenheilkd. 2004;221(3): 197–203.CrossRefPubMedGoogle Scholar
  29. 29.
    Shaikh AA, Damji KF, Mintsioulis G, Gupta SK, Kertes PJ. Bilateral epithelial downgrowth managed in one eye with intraocular 5-fluorouracil. Arch Ophthalmol. 2002;120(10):1396–1398.PubMedGoogle Scholar
  30. 30.
    McAllister IL, Meyers SM, Meisler DM, et al. Epithelial downgrowth. Ophthalmic Surg. 1988;19(10):713–714.PubMedGoogle Scholar
  31. 31.
    Costa VP, Katz LJ, Cohen EJ, Raber IM. Glaucoma associated with epithelial downgrowth controlled with Molteno tube shunts. Ophthalmic Surg. 1992;23:797–800.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Matthew C. Willett
    • 1
  • Sami Al-Shahwan
    • 2
  • Deepak P. Edward
    • 3
  1. 1.Department of OphthalmologySumma Health SystemsAkronUSA
  2. 2.Department of Glaucoma ServicesKing Khaled Eye Specialist HospitalRiyadhKingdom of Saudi Arabia
  3. 3.Department of OphthalmologyNortheastern Ohio Universities College of Medicine, Summa Health SystemsAkronUSA

Personalised recommendations