A Rare Presentation of Epithelial Downgrowth Following Incisional Astigmatism Correction

Purpose: To present a case of epithelial downgrowth, which is a known complication of various corneal surgeries, including corneal laceration repair, cataract surgery, and corneal transplantation. Case Report: We present a 45-year-old male with progressive epithelial downgrowth after incisional astigmatism correction and phacoemulsification in his right eye with a history of penetrating keratoplasty. The preoperative best-corrected visual acuity was 20/100 with a refraction of −9.00 −6.00 × 120. The patient underwent phacoemulsification combined with an incision in steep meridian to correct the corneal astigmatism. One month post operation, a sheet-like membrane (4 × 5 mm) was observed in the paracentral zone of cornea, attached to the incisional region. Due to progression of epithelial downgrowth, the patient underwent repeat penetrating keratoplasty, and the tissue specimen was sent for histopathological examination. The pathology exam revealed an epithelial layer posterior to the deep stroma and anterior to the Descemet membrane. Conclusion: Our case highlights the possibility of epithelial downgrowth in the layer between deep stroma and Descemet membrane.