5-Fluorouracil for Epithelial Downgrowth After Descemet Stripping Automated Endothelial Keratoplasty

Wong, Ryan; Greene, Daniel P.; Shield, David R.; Eberhart, Charles G.; Huang, John J.; Shayegani, Aryan

doi:10.1097/ico.0b013e3182a9fc85

Cited by 27 publications

(19 citation statements)

References 10 publications

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“…Two papers report complete regression of an epithelial downgrowth in eyes that had corneal grafting using intracameral 5-FU. 8,9 Wong et al 10 report a case of epithelial downgrowth after Descemet-stripping automated endothelial keratoplasty (DSAEK) successfully treated with 5-FU. However, the case had a short follow-up.…”

Section: Discussionmentioning

confidence: 98%

Managing epithelial downgrowth after clear corneal phacoemulsification

Oliveira

Bordón

Mori

et al. 2015

Journal of Cataract and Refractive Surgery Online Case Reports

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We present a case in which epithelial downgrowth developed after uneventful clear corneal phacoemulsification. The diagnosis of epithelial downgrowth was confirmed by clinical features and anterior segment optical coherence tomography (OCT), high-frequency ultrasound (US), and confocal microscopy. Intracameral 5-fluorouracil (5-FU) was administered 3 times to control epithelial growth. Sixteen months after the last intervention, the epithelial layer did not appear to have increased. Although 5-FU seemed to be effective in preventing epithelial growth, we cannot be sure epithelial cell growth will not progress over time. Corneal melting is a potential complication of this treatment. Anterior segment OCT and high-frequency US were helpful tools in the diagnosis of epithelial downgrowth after clear corneal phacoemulsification.

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Section: Discussionmentioning

confidence: 98%

Managing epithelial downgrowth after clear corneal phacoemulsification

Oliveira

Bordón

Mori

et al. 2015

Journal of Cataract and Refractive Surgery Online Case Reports

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“…Several previous reports also described an initial positive response to 5FU therapy, and longer-term outcomes at 5 to 6 months ranged from eradication of EDG [11–13] to recurrent EDG and corneal decompensation [10]. Complications of 5FU injection may include epithelial defect and possibly corneal decompensation.…”

Section: Discussionmentioning

confidence: 99%

Epithelial Downgrowth after Intraocular Surgery Treated with Intracameral 5-Fluorouracil

Goldberg²,

Eagle

et al. 2015

Case Reports in Ophthalmological Medicine

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Purpose. To present the clinical and histopathologic correlation of two cases of epithelial downgrowth (EDG) after prior intraocular surgery. Methods. Observational case reports. Results. We present two cases of EDG occurring after intraocular surgery. In both cases, after two anterior chamber injections of 5-fluorouracil (5FU), the area of EDG initially regressed. In Case 1, a limited area of EDG eventually recurred, and penetrating keratoplasty with cryotherapy was curative. In Case 2, subsequent corneal edema required Descemet-stripping automated endothelial keratoplasty, and the patient remained clinically free of EDG without further treatment. Conclusion. Intracameral 5FU may have a role in the treatment of EDG after intraocular surgery, though its precise utilization and impact remain to be defined.

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“…5-FU is a pyrimidine-analog antimetabolite commonly used in glaucoma filtering surgeries and bleb revisions, dacryocystorhinostomy procedures, pterygium surgeries, conjunctival neoplasias, and vitreoretinal surgery, due to its antiproliferative and antiscarring properties [ 52 , 53 ]. Recently, there have been several reports exhibiting the use of 5-FU for successful treatment of diffuse epithelial downgrowth [ 54 – 57 ] but use of this medication in the management of iris implantation cysts has not been previously reported. Iris implantation cyst occurrence has been attributed to the prolific nature of the epithelial cells along the wall of the cyst cavity [ 3 ].…”

Section: Review Of the Literature And Discussionmentioning

confidence: 99%

The Diagnostic and Therapeutic Challenges of Posttraumatic Iris Implantation Cysts: Illustrative Case Presentations and a Review of the Literature

Venkateswaran

Ching

Fischer

et al. 2015

Case Reports in Ophthalmological Medicine

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Posttraumatic iris implantation cysts are rare ocular findings that are often associated with poor visual outcomes. Iris implantation cysts can present clinicians with diagnostic and therapeutic challenges given their variable presentations and frequently destructive nature. In this paper, we provide descriptions of two unusual cases of posttraumatic iris implantation cysts. The first case is of a recurrent keratin-filled iris implantation cyst that developed after open globe injury and intraocular implantation of cilia and was treated with cyst debulking procedures, injections of 5-Fluorouracil, and iridocyclectomy. The second case is of recurrent posttraumatic serous iris implantation cysts that were treated with laser, cyst aspiration, and injections of 5-Fluorouracil. We use these cases as a platform to discuss the different manifestations of implantation cysts, the roles of anterior segment optical coherence tomography, ultrasound biomicroscopy, and histopathology in facilitating timely and accurate diagnosis and review the range of available therapeutic modalities. We discuss conservative treatment approaches, including the novel use of 5-Fluorouracil therapy as an adjunct therapy, as well as more aggressive surgical excision requiring ocular reconstruction. Through a discussion of these cases and review of the literature, we provide recommendations to assist clinicians in managing this uncommon but vision-threatening condition and minimizing complications.

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5-Fluorouracil for Epithelial Downgrowth After Descemet Stripping Automated Endothelial Keratoplasty

Abstract: Epithelial downgrowth that occurs after performing a DSAEK can be treated successfully using intracameral 5-FU.

Cited by 27 publications

References 10 publications

Managing epithelial downgrowth after clear corneal phacoemulsification

Managing epithelial downgrowth after clear corneal phacoemulsification

Epithelial Downgrowth after Intraocular Surgery Treated with Intracameral 5-Fluorouracil

The Diagnostic and Therapeutic Challenges of Posttraumatic Iris Implantation Cysts: Illustrative Case Presentations and a Review of the Literature

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