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Late corneal edema due to retained foldable lens fragment.

Gokhale NS - Indian J Ophthalmol (2009 May-Jun)

Bottom Line: During implantation of the foldable lens, one haptic of the intraocular lens fractured at the optic haptic junction.This caused lens decentration, necessitating an intraocular lens exchange ten days later.A retained haptic of the intraocular lens was seen in the inferior anterior chamber angle.

View Article: PubMed Central - PubMed

Affiliation: Gokhale Eye Hospital and Eyebank, Mumbai-400 028, India. gokhlay@vsnl.com

ABSTRACT
Late onset of corneal edema after cataract surgery is an unusual complication. We report a case of corneal edema presenting one month after cataract surgery. During implantation of the foldable lens, one haptic of the intraocular lens fractured at the optic haptic junction. This caused lens decentration, necessitating an intraocular lens exchange ten days later. The patient was recovering well but presented again two weeks later with a drop in vision due to corneal edema. A retained haptic of the intraocular lens was seen in the inferior anterior chamber angle. After surgical removal of the retained haptic the corneal edema fully resolved. Retained intraocular lens fragments can cause corneal endothelial damage, which may be reversible with an early diagnosis and intervention.

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Intraoperative picture of the explanted intraocular lens fragment
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Figure 0003: Intraoperative picture of the explanted intraocular lens fragment

Mentions: A 65-year-old patient was referred with slowly progressing corneal edema after a complicated cataract surgery. The patient had undergone phacoemulsification with foldable intraocular lens (IOL) implantation (Rayner Centerflex 570C +21D) one month before presentation. During implantation one haptic of the IOL fractured at the optic haptic junction. Due to non-availability of a second IOL, the IOL was not exchanged. Postoperatively the patient developed IOL decentration and the IOL was exchanged on the tenth postoperative day. The IOL was explanted in a piecemeal fashion through the original incision. A new foldable IOL of the same specification was implanted using a disposable injector supplied with the lens. The patient was recovering well after the IOL exchange achieving a best corrected vision of 20/20. The patient presented two weeks later with a drop in vision. On examination, corneal edema involving the lower half of the cornea was noted by the operating surgeon and the patient was referred for cornea evaluation. On slit-lamp examination there was corneal edema [Fig. 1] involving the inferior half of the cornea, there were no keratic precipitates and no evidence of a Descemet's membrane detachment. A careful examination revealed a small piece of the IOL haptic in the inferior anterior chamber angle. On dilated examination the intraocular lens was in the bag with both haptics in situ and the posterior capsule was intact. Fundus examination was normal. No other lens or nuclear fragments were seen. Removal of the IOL haptic was advised and it was performed four days later. Under peribulbar block a side port incision was made and viscoelastic was used to viscoexpress [Figs. 2 and 3] the broken haptic. The viscoelastic was removed and the side port was closed by one 10–0 nylon suture. Postoperatively gatifloxacin 0.3% with dexamethasone sodium phosphate 0.1% eye drops (Gatilox-DM, Sun Pharma, India) were prescribed six times daily and hypertonic saline 5% (Hypersol - 5, Jawa Pharma, India) eye drops four times daily. Six weeks postoperatively the cornea was clear [Fig. 4] and the patient achieved best corrected visual acuity of 20/20.


Late corneal edema due to retained foldable lens fragment.

Gokhale NS - Indian J Ophthalmol (2009 May-Jun)

Intraoperative picture of the explanted intraocular lens fragment
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2683446&req=5

Figure 0003: Intraoperative picture of the explanted intraocular lens fragment
Mentions: A 65-year-old patient was referred with slowly progressing corneal edema after a complicated cataract surgery. The patient had undergone phacoemulsification with foldable intraocular lens (IOL) implantation (Rayner Centerflex 570C +21D) one month before presentation. During implantation one haptic of the IOL fractured at the optic haptic junction. Due to non-availability of a second IOL, the IOL was not exchanged. Postoperatively the patient developed IOL decentration and the IOL was exchanged on the tenth postoperative day. The IOL was explanted in a piecemeal fashion through the original incision. A new foldable IOL of the same specification was implanted using a disposable injector supplied with the lens. The patient was recovering well after the IOL exchange achieving a best corrected vision of 20/20. The patient presented two weeks later with a drop in vision. On examination, corneal edema involving the lower half of the cornea was noted by the operating surgeon and the patient was referred for cornea evaluation. On slit-lamp examination there was corneal edema [Fig. 1] involving the inferior half of the cornea, there were no keratic precipitates and no evidence of a Descemet's membrane detachment. A careful examination revealed a small piece of the IOL haptic in the inferior anterior chamber angle. On dilated examination the intraocular lens was in the bag with both haptics in situ and the posterior capsule was intact. Fundus examination was normal. No other lens or nuclear fragments were seen. Removal of the IOL haptic was advised and it was performed four days later. Under peribulbar block a side port incision was made and viscoelastic was used to viscoexpress [Figs. 2 and 3] the broken haptic. The viscoelastic was removed and the side port was closed by one 10–0 nylon suture. Postoperatively gatifloxacin 0.3% with dexamethasone sodium phosphate 0.1% eye drops (Gatilox-DM, Sun Pharma, India) were prescribed six times daily and hypertonic saline 5% (Hypersol - 5, Jawa Pharma, India) eye drops four times daily. Six weeks postoperatively the cornea was clear [Fig. 4] and the patient achieved best corrected visual acuity of 20/20.

Bottom Line: During implantation of the foldable lens, one haptic of the intraocular lens fractured at the optic haptic junction.This caused lens decentration, necessitating an intraocular lens exchange ten days later.A retained haptic of the intraocular lens was seen in the inferior anterior chamber angle.

View Article: PubMed Central - PubMed

Affiliation: Gokhale Eye Hospital and Eyebank, Mumbai-400 028, India. gokhlay@vsnl.com

ABSTRACT
Late onset of corneal edema after cataract surgery is an unusual complication. We report a case of corneal edema presenting one month after cataract surgery. During implantation of the foldable lens, one haptic of the intraocular lens fractured at the optic haptic junction. This caused lens decentration, necessitating an intraocular lens exchange ten days later. The patient was recovering well but presented again two weeks later with a drop in vision due to corneal edema. A retained haptic of the intraocular lens was seen in the inferior anterior chamber angle. After surgical removal of the retained haptic the corneal edema fully resolved. Retained intraocular lens fragments can cause corneal endothelial damage, which may be reversible with an early diagnosis and intervention.

Show MeSH
Related in: MedlinePlus