A case of corneal epithelial downgrowth after penetrating keratoplasty treated by intracameral 5-fluorouracil injection and mitomycin C

Background: Corneal epithelial downgrowth is an uncommon, yet potentially sight-threatening complication of intraocular surgery or trauma with poor prognosis. We hereby describe a case of epithelial downgrowth after penetrating keratoplasty which was treated by intracameral 5fluorouracil injection. Case description: In 2019, penetrating keratoplasty was performed for a 69-year-old man with pseudophakic bullous keratopathy. Six months after penetrating keratoplasty, an endothelial opacity suspicious of epithelial downgrowth was noted. Two treatments of intracameral 5fluorouracil injection were performed at the eighth and ninth month after penetrating keratoplasty, which allowed the epithelial downgrowth to become quiescent. A repeated penetrating keratoplasty with intracameral application of mitomycin C was subsequently performed without reactivation of the epithelial downgrowth. Conclusion: Intracameral 5-fluorouracil injection is effective in halting disease progression in epithelial downgrowth.