Purpose: To report a rare case of epithelial downgrowth (EDG) after cataract surgery successfully treated with surgical excision, cryotherapy, and a single intraocular methotrexate (MTX) injection. Methods: Retrospective case report with multimodal anterior segment imaging over 10 months of follow-up. Results: A 69-year-old man presented with chronic wound leak and associated EDG that developed 5 years after cataract extraction. The patient underwent surgical epithelial removal guided by intraoperative anterior segment optical coherence tomography (OCT), adjunctive wound cryotherapy, and a single anterior chamber MTX injection (50 μL, 400 μg, 8 mg/mL). Histopathologic examination confirmed that the epithelium was derived from the ocular surface. Postoperatively, the cornea remained Seidel-negative with gradual resolution of haze and no evidence of edge recurrence at 10 months. Central corneal thickness, endothelial cell density, and cell morphology remained stable, indicating preserved endothelial integrity. Imaging confirmed absence of recurrent epithelial proliferation and maintenance of corneal integrity. Conclusions: This case demonstrates the potential for successful management of EDG using a single intraocular MTX injection after surgical removal and cryotherapy, achieving sustained remission and preservation of endothelial integrity while minimizing MTX exposure and associated toxicity.
Haidar et al. (Tue,) studied this question.