Conjunctival Epithelial Down growth Following Trabeculectomy Simulating Chronic Postoperative Endophthalmitis

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Epithelial down growth is a rare and sight-threatening eye condition which can occur after penetrating trauma or any intraocular surgery. Epithelial cells invade the intraocular structures through an incompetent wound and proliferate wildly causing inflammation and multiple damages .We report a case of a 6-year-old patient who presented to the emergency room for a decreased visual acuity, pain over a week in his right eye. Trabeculectomy surgery for congenital glaucoma was performed three years prior and revised with mitomycin C 6 months ago. Slit lamp examination of the affected eye showed conjunctival hyperemia, anterior chamber inflammation, a drawn upwars pupil, in this upper parts we can clearly see a membrane originating from the superior trabeculectomy site with neovascularization on the membrane, a yellow reflect light in pupil area interfering with the fundus examination and highly suggestive of chronic endophthalmitis. Vitreous tap was performed which allowed us to eliminate an infectious origin and revealed the presence of squamous epithelial cells that are not found inside the eye. The diagnose of epithelial down growth resulting to inflammation and vitreous hemorrhage following trabeculectomy was made. Local and general corticotherapy was started. Epithelial down growth treatment is variable, studies showed that patients treated surgically underwent fewer enucleations than those treated medically or not treated.