During a two-year period we diagnosed and managed four cases of epithelial downgrowth in aphakic patients (two men and two women, 42 to 76 years old) after keratoplasty. Several clinical findings seemed typical of epithelial downgrowth in this setting. When iritis was present, it was unusual in that the aqueous humor, contained large clumps of cellular material and the degree of apparent inflammation was out of proportion to the ciliary flush or symptoms. A posterior corneal line was present in two cases. It resembled an endothelia graft rejection line, but there were no associated keratic precipitates. Also, no graft edema occurred peripheral to a retrocorneal line in either case. Glaucoma was abrupt in onset and difficult to treat. Cytopathologic studies of aqueous aspirate may be needed to confirm the diagnosis. The long-term prognosis for useful vision in our patients was poor but early diagnosis and surgical intervention might possibly lead to a more favorable outcome.
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