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Prompt identification of corneal edema after cataract surgery needed for quick recovery
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KOLOA, Hawaii — Causes of corneal edema after cataract surgery are varied and must be identified and eliminated quickly, according to a speaker here.
“In general, when you have corneal edema after cataract surgery, eliminate the inciting cause, be it a fragment, dislocated lens or [Descemet’s membrane] detachment. Treat these patients aggressively with steroids and keep in mind they may need corneal transplantation,” Terry Kim, MD, said at Hawaiian Eye 2017.
Terry Kim
The two most common conditions that can cause corneal edema after cataract surgery are Fuchs’ dystrophy and retained lens fragments after surgery. Fuchs’ dystrophy can be treated with a phacoemulsification procedure alone or a Descemet's stripping endothelial keratoplasty (DSEK) triple procedure, Kim said.
If a patient has no morning blurring of vision, just mild guttae or minimal edema, and the clinician is comfortable with the patient’s lens density, a phacoemulsification procedure alone is appropriate. If a patient has morning blurring of vision, signs of epithelial edema, significant guttae and other factors, then a DSEK triple procedure is appropriate, Kim said.
In a retrospective case series at the Duke Eye Center, Kim found 60% of patients with corneal edema have a retained lens fragment after cataract surgery, with 80% being diagnosed with a lens fragment 1 day after cataract surgery.
“Do not wait on this. If you identify one, you should really take these patients immediately to the OR. In these patients, the edema that they have tends to linger even after you remove the fragment. It’s much worse the longer you wait,” Kim said.
If the lens fragment is not diagnosed and removed quickly, patients run the risk of developing corneal edema or decompensation and may require transplantation, he said. – by Robert Linnehan.
Reference:
Kim T. Corneal edema following cataract surgery. Presented at: Hawaiian Eye; Jan. 14-20, 2017; Koloa, Hawaii.
Disclosure: Kim reports he is a consultant for Acucela, Aerie, Alcon/Novartis, Allergan/Actavis, Bausch + Lomb/Valeant, BlephEx, CoDa Therapeutics, Foresight Biotherapeutics, Kala Pharmaceuticals, Novabay Pharmaceuticals, Ocular Systems/SightLife, Ocular Therapeutix, Oculeve, Omeros, PowerVision, Presbyopia Therapies, Shire, Stealth BioTherapeutics, TearLab and TearScience.