The most effective treatment of glaucoma associated with epithelial downgrowth is to insert a drainage implant

The Science behind the Tip

Epithelial downgrowth into the anterior chamber is an extremely rare cause of glaucoma after anterior segment incisional surgery and after penetrating trauma. The initial predisposing factor for this condition is a persistent wound leak. The key to the management is the early recognition of the thin translucent membrane on the posterior surface of the cornea. In practice, however, this diagnosis is usually made at a relatively late stage, when glaucoma is already present.

When epithelial downgrowth is present, radical surgery is usually required (1). Intraocular 5-fluorouracil can be helpful (2). The management of the associated glaucoma is difficult and trabeculectomy fails because of closure of the sclerostomy by epithelial sheets. Implantation of a drainage tube is an effective palliative treatment and usually results in intraocular pressure control (3).

Contributor: John Salmon, Oxford

References

1. Stark WJ, Michels RG, Maumenee AE, Cupples H. Surgical management of epithelial ingrowth. Am J Ophthalmol. 1978;85:772.

2. Costa VP, Katz LJ, Cohen EJ , Raber IM. Glaucoma secondary to epithelial downgrowth and 5-fluorouracil. Ophthalmic Surg. 1990;21:704.

3. Fish LA, Heuer DK, Baerveldt G et al. Molteno implantation for secondary glaucoma associated with advanced epithelial downgrowth. Ophthalmology. 1990;97:557

Tip Reviewer: Roger Hitchings
Tip Editors: Ann Hoste, John Salmon and John Thygesen