title: Epithelial downgrowth after clear cornea phacoemulsification: report of two cases and review of the literature.
abstract: OBJECTIVE
  To report two cases of diffuse epithelial downgrowth after clear cornea phacoemulsification and to review the different treatment options for this ominous disease.
  
  
  METHODS
  Two interventional case reports.
  
  
  METHODS
  Retrospective review of two eyes from two different patients in whom epithelial downgrowth developed 7 and 3 months after uneventful clear cornea phacoemulsification. In the first case, the epithelial invasion seemed to be growing from the temporal incision site onto the corneal endothelium toward the visual axis. Cryotherapy was applied to the affected cornea, with control of the growing membrane. A penetrating keratoplasty was performed to restore visual function. In the second patient, the membrane was attached to the iris and posterior cornea and was confirmed by diagnostic argon laser photocoagulation. This case was surgically treated with en bloc excision and a corneoscleral graft.
  
  
  METHODS
  Visual acuity at the final follow-up visit.
  
  
  RESULTS
  Surgical treatment of the epithelial downgrowth was different for both patients. In the postoperative period, a best-corrected visual acuity of 20/60 and 20/30 was achieved in each case. No regrowth of the membrane was observed.
  
  
  CONCLUSIONS
  Treatment of epithelial downgrowth is controversial. We present two cases of epithelialization of the anterior chamber with either clinical or histologic confirmation after clear cornea sutureless phacoemulsification. Surgical treatment should be attempted promptly to obtain a good visual prognosis.
authors.affiliation: Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Vargas
authors.forename: David T
authors.initials: DT
authors.lastname: Vroman
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Solomon
authors.forename: Mike P
authors.initials: MP
authors.lastname: Holzer
authors.forename: Marcela
authors.initials: M
authors.lastname: Escobar-Gomez
authors.forename: Josef M
authors.initials: JM
authors.lastname: Schmidbauer
authors.forename: David J
authors.initials: DJ
authors.lastname: Apple
mesh_terms: D000368:Aged; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D003316:Corneal Diseases / Q000209:etiology* / Q000601:surgery; D017679:Cryotherapy; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D017075:Laser Coagulation; D008297:Male; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D014792:Visual Acuity