Confocal Microscopic Diagnosis of Epithelial Downgrowth

Abstract

The purpose of this study was to report the confocal microscopic, characteristics of epithelial downgrowth and the clinical utility of serial confocal examinations in the management of epithelial downgrowth. Retrospective case review of 3 eyes from 3 patients that developed epithelial downgrowth after ocular surgery with penetrating ocular trauma and literature review. Two cases developed epithelial downgrowth and a retrocorneal membrane after both penetrating ocular trauma and multiple intraocular surgeries. A third case developed epithelial downgrowth presenting as a membranous growth noted on the endothelial surface after multiple intraocular surgeries. In all cases, confocal microscopy revealed round, hyperreflective nuclei characteristic of epithelial cells at the level of the endothelium, and in 2 cases, the diagnosis was confirmed by histopathologic evaluation. In cases 2 and 3, confocal microscopic analysis proved useful in following epithelial regression after 5-fluorouracil injection, and in case 3, confocal microscopy proved to be potentially more sensitive in identifying residual epithelial downgrowth than routine light microscopy. Confocal microscopy can definitively diagnose epithelial downgrowth occurring after previous ocular surgery or ocular trauma and may prove useful for following downgrowth after intervention.