Abstract
Background Intraocular epithelial downgrowth is a rare but potentially devastating posttraumatic
complication. If left untreated, this may result in corneal decompensation, secondary
angle-closure glaucoma, retinal detachment and blindness.
Patient and Method A 10-year-old patient with penetrating globe injury and delayed wound management
elsewhere presented with corneal melting and decompensation, retinal detachment
and ocular hypotony. Following penetrating keratoplasty, cyclopexy and vitrectomy,
corneal melting in the interface with renewed retinal detachment was noted within
days. The hopeless
prognosis required enucleation of the globe.
Results Optical coherence tomography revealed not only corneal melting, but also markedly
hyperreflective structures posterior to the cornea. Immunohistology demonstrated diffuse
multi-layered nonkeratinised squamous cell epithelium on the posterior corneal
surface, iris, ciliary bodies, and retina, as well as below the choroid, with renewed
tractional retinal
detachment.
Conclusion Posttraumatic epithelial downgrowth may result in tractional retinal detachment,
cyclodialysis cleft and/or corneal melting. Hyperreflective membrane deposits on OCT
may
be indicative of diffuse epithelial downgrowth. Especially in children, prompt
wound closure in globe injuries is vital to avoid this serious posttraumatic complication.
Key words
intraocular epithelial invasion - hypotony - retinal detachment - corneal melting
- secondary angle closure glaucoma
