Endoscopic Photocoagulation in the Management of Epithelial Downgrowth

PURPOSE:Epithelial downgrowth, a rare but devastating complication of intraocular surgery and penetrating ocular trauma, remains a therapeutic dilemma in ophthalmology. We present an interventional case report of an instance successfully treated with diode laser photocoagulation by using a purely endoscopic approach. METHODS:Case report and literature review. RESULTS:An 81-year-old woman initially presented with worsening visual acuity, diffuse corneal edema, band keratopathy, peripheral anterior synechiae, and an atypical iris cyst with angle involvement. Histopathologic examination of the iris cyst revealed nonkeratinized stratified squamous epithelium consistent with epithelial downgrowth. After thorough treatment of the epithelial downgrowth by an endoscopic technique, penetrating keratoplasty and cryoablation of the remaining corneal tissue were performed for visual rehabilitation. One year after treatment, no signs of recurrence were present. CONCLUSIONS:Diode photocoagulation by using an endoscopic approach potentially offers an effective, safe, and minimally invasive surgical approach for the management of epithelial downgrowth in patients with corneal opacity.