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To remove or not to remove: revealing a piece of ophthalmic instrument in the eye after DSAEK

Poster Details

First Author: A. Cwiklinska-Haszcz POLAND

Co Author(s):    T. Zarnowski   A. Wlaz                 

Abstract Details

Purpose:

To report a case of revealing a tiny piece of instrument (chopper ending), consideration about method of treatment and final case solution.

Setting:

Department of Ophthalmology, Medical University, Lublin, Poland.

Methods:

A patient after uneventful cataract extraction in 2014 was referred with bullous keratopathy. DSAEK (Descement Stripping Automated Keratoplasty) was scheduled and done in September 2016. Before surgery VA was CF. During keratoplasty no signs of foreign body were discovered. After one month cornea become transparent, covered with healthy epithelium, graft was attached and clear. UVA=0,2. Unfortunately small object was visible at the margin of the graft inside an anterior chamber. Six months after DSAEK patient undergone foreign body extraction, which was not firmly attached to the cornea and the graft.

Results:

Foreign body extraction was done through paracentesis in local anesthesia. BCVA=0,7 was two weeks after surgery. No graft rejection or failure was observed. Endothelial cell count was adequate to the time after DSAEK and stable. Examination of the object revealed small part of chopper- instrument probably used during cataract extraction 2 years before. No such instrument was needed while performing posterior lamellar keratoplasty.

Conclusions:

No reliable evidence for relation between foreign body and endothelial damage leading to corneal decompensation is seen, although it cannot be excluded. Poor attachment to the cornea suggests possible floating of the object in the anterior or posterior chamber or in the angle. Special care should be introduced in cases of uneventful phacoemulsification in eyes with healthy endothelium followed by bullous keratopathy and difficult to explain corneal decompensation.

Financial Disclosure:

NONE

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