Conjunctival epithelial downgrowth following trabeculectomy simulating chronic postoperative endophthalmitis

¹Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco

^&Corresponding author
Kawtar Bouirig, Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco

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Epithelial downgrowth is a rare and sight-threatening eye condition which can occur after penetrating trauma or any intraocular surgery. Epithelial cells invade the intraocular structures through an incompetent wound and proliferate wildly causing inflammation and multiple damages. We report a case of a 6-year-old patient who presented to the emergency room for a decreased visual acuity, pain, tearing, photophobia over a week in his right eye. Trabeculectomy surgery for congenital glaucoma was performed three years prior and revised with mitomycin C 6 months ago. Slit lamp examination of the affected eye showed visual acuity limited to hand motion, conjunctival hyperhemia, anterior chamber inflammation, a drawn upwars pupil, in this upper parts we can clearly see a membrane originating from the superior trabeculectomy site with neovascularization on the membrane, a yellow reflect light in pupil area interfering with the fundus examination and highly suggestive of chronic endophthalmitis. The patient was treated as such but without improvement, therefore a vitreous tap was performed which allowed us to eliminate an infectious origin and revealed the presence of squamous epithelial cells that are not found inside the eye. The diagnose of epithelial downgrowth resulting to inflammation and vitreous hemorrhage following trabeculectomy was made. Local and general corticotherapy was started, the parents refused the surgical excision of the membrane, the eye eventually became phthisical. The differential diagnosis of epithelial downgrowth includes secondary endothelial proliferation, iridocorneal endothelial (ICE) syndrome, congenital heterotopic inclusion cyst and metastatic carcinoma. Epithelial downgrowth treatment is variable, studies showed that patients treated surgically underwent fewer enucleations than those treated medically or not treated.

Figure 1: A, B) slit lamp examination of the right eye showing a neovascularized membrane invading the eyeball corresponding to conjunctival epithelial downgrowth (arrow)