Abstract
Purpose :
Epithelial downgrowth (EDG) is a relatively infrequent complication of intraocular surgery or eye trauma. It involves the extension of corneal or conjunctival epithelium into the anterior chamber. The literature is sparse on this condition and it remains a diagnostic challenge, both histologically and clinically. We have conducted a 24 year single-institution clinical and pathological retrospective review of cases.
Methods :
Cases of histologically suspected EDG were identified through the electronic record system at Casey Eye Pathology Laboratory. Keywords entered in the search included “epithelial ingrowth” or “epithelial downgrowth” and was performed from the dates 01/1999 to 03/2023.
Results :
64 patients with suspected EDG on pathology were included in the study. The majority of patients had a complex surgical history, defined as 2 or more intraocular surgeries (51%; n=39). History of ocular trauma was noted in 19% of cases (n=12). The highest documented clinical presentations included corneal graft failure (45%; n=29) and bullous keratopathy (12.5%; n=8). Of the graft failure cases, 52% were penetrating keratoplasties (n=15). EDG was clinically suspected in 14% of cases (n=9). Overall, there has been an uptrend of histologically suspected cases from 1999 to present at our institute, with the highest number of suspected cases in the years 2018-2023 compared to the 1999-2005-, 2006-2011, and 2012–2017-time intervals.
Conclusions :
This report is a retrospective 24 year review of a single institution’s electronic pathology records of cases with clinical and/or histological suspicion for epithelial downgrowth. EDG is diagnostically complex as reflected in our study and many suggestive features on pathology are not definitive. Discordance between histology findings and clinical manifestations were observed. Changes in incidence over a 24 year period may reflect more recent higher levels of surveillance by clinician and pathologist.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.