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

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

doi: 10.1097/ICO.0b013e3182a9fc85
Case Report

Purpose: To report the use of intracameral 5-fluorouracil (5-FU) to treat epithelial downgrowth after performing a Descemet-stripping automated endothelial keratoplasty (DSAEK).

Methods: We describe the case of a 79-year-old woman who underwent a DSAEK for pseudophakic Fuchs endothelial corneal dystrophy. The patient required 2 repeat DSAEKs for graft failure and persistent, visually significant interface haze. Six months after the third and most recent DSAEK, the patient was followed up and found to have a visual acuity of 20/100. On examination, the patient continued to have a persistent interface haze. However, the patient also had a cellular anterior chamber reaction despite the administration of frequent topical corticosteroids, and subtle findings of a translucent, membranous growth over the iris. Argon laser photocoagulation of the area resulted in a whitening response, characteristic of epithelial growth.

Results: Epithelial downgrowth was diagnosed, and intracameral 5-FU was administered. One month after the injection was given, the patient's examination results and vision improved to 20/60. Six months after the single injection, the patient had a clear DSAEK graft without interface haze, a quiet chamber, and 20/30 visual acuity.

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

*Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT; and

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.

Reprints: Aryan Shayegani Department of Ophthalmology and Visual Science, Yale University School of Medicine, Yale-New Haven Hospital, 40 Temple St, Suite 3D, New Haven, CT 06510 (e-mail:

Supported in part by an unrestricted grant to Yale University, Department of Ophthalmology, from Research to Prevent Blindness.

The authors have no conflicts of interest to disclose.

Received June 09, 2013

Accepted August 23, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.