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Photo Essay
February 1999

Epithelial Downgrowth Following Phacoemulsification Through a Clear Cornea

Arch Ophthalmol. 1999;117(2):283. doi:10.1001/archopht.117.2.283

AN 80-YEAR-OLD woman had an uncomplicated phacoemulsification cataract operation through a temporal clear corneal wound that was not sutured at the conclusion of the surgery. The immediate postoperative course was uncomplicated; however, 5 months postoperatively, there was temporally displaced corectopia of the pupil. Three years postoperatively, the patient complained of poor vision and was referred to us. The right eye had a broad iris synechia to the temporal peripheral cornea. A peripheral white retrocorneal membrane was present inferiorly that extended 2 mm centrally and into the anterior chamber angle. The retrocorneal membrane covered the iris from the 2-o'clock position to the 10-o'clock position and harbored visible vessels. The intraocular pressure was 32 mm Hg. A diagnosis of epithelial downgrowth was confirmed with multiple photocoagulative burns of argon laser (250-mW power, 100-µm spot size, 0.1-second duration) to the iris. Burns to the retrocorneal membrane turned white, and burns to uninvolved iris turned black (Figure 1). Surgical intervention was recommended, but the patient could not be convinced of the urgency. Examination 3 months later showed superior extension of the retrocorneal membrane. Finally, excision of the retrocorneal membrane from the posterior cornea and the iris, as well as cryotherapy to the angle, was performed. Tissue specimens revealed stratified squamous epithelium overlaying anterior chamber structures (Figure 2).

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