Epithelial downgrowth following clear cornea phacoemulsification in a buphthalmic eye.

LETTERS If you have a burning desire to respond to a paper published in BJO, why not make use of our ''rapid response'' option? Log on to our web site (www.bjophthalmol. com), find the paper that interests you, and send your response via email by clicking on the ''eLetters'' option in the box at the top right hand corner. Providing it isn't libellous or obscene, it will be posted within seven days. You can retrieve it by clicking on ''read eLetters'' on our homepage. The editors will decide as before whether to also publish it in a future paper issue. Epithelial downgrowth is a rare complication which can occur following anterior segment surgery and penetrating ocular injury. A prevalence as high as 16–29% among eyes enucleated after cataract surgery has been reported in the older literature, but advancements in the microsurgical techniques have decreased that rate to less than 0.2%. 1 To our knowledge only two cases of epithelial down-growth following clear corneal phacoemulsi-fication have been reported. 2 3 We present the clinical and histopathological features, and the successful surgical management, of a patient with extensive intraocular involvement of epithelial downgrowth with following clear corneal phacoemulsification. A 26 year old man was followed up for bilateral congenital glaucoma. He had undergone several bilateral trabeculectomies in the past. Preoperatively his intraocular pressures (IOP) were well controlled with no medication. He underwent phacoemulsification with implantation of a poly(methylmethacrylate) (PMMA) lens through a 5 mm superior clear corneal wound in the right eye. The corneal wound was closed with Nylon sutures, as the eye wall was thin secondary to buphthalmos and the temporal end of the wound was irregular extending to the limbus. At the end of the surgery the wound appeared secured with a deep anterior chamber. Two weeks postoperatively he presented with wound leak from the corneal section. A conjunctival hood was fashioned over the corneal wound in an attempt to prevent wound leak. Four weeks later he developed an epithelial down-growth in the form of a retrocorneal membrane with involvement of the iris from the 7 o'clock to 2 o'clock position (fig l, top). He underwent a corneo-sclero-iridocyclectomy with removal of the IOL and posterior capsule combined with anterior vitrectomy. No ad-junctive cryotherapy was used. A horseshoe-shaped corneoscleral graft was sutured in place. Histopathological examination confirmed extensive downgrowth of non-keratinised stratified squamous epithelium involving the cornea, the angle, anterior and …