A North American case series demonstrated intraocular methotrexate (MTX) eradicated the sheet-like form of epithelial downgrowth (EDG) in 70% of treated eyes. 

Writing in the British Journal of Ophthalmology, researchers from Canada and the US described using 400µm/0.1ml MTX injections (twice per week or weekly) to treat 10 eyes of nine patients with intraocular-surgery-associated EDG. At follow-up of 54±36 months, seven eyes had achieved EDG eradication, while eight patients developed surface epitheliopathy (which was used to titrate MTX treatment) and six patients also developed endothelial failure, said authors. 

Intraocular MTX may be used effectively to achieve eradication of EDG in cases where surgery is not amenable; however, further recommendations to guide treatment remain warranted, they concluded. 

A 2022 paper by Moran Eye Center, Utah’s Dr Majid Moshirfar et al, described epithelial downgrowth as a rare but vision-threatening complication of penetrating ocular trauma or intraocular surgery. In the disease, epithelial cells enter the anterior chamber and proliferate into intraocular structures. Of the three epithelialisation forms it can take, the sheet-like, diffuse form is the most common, the most aggressive and more frequently leads to complications such as secondary glaucoma, they said.