Intraoperative Fibrinous Reaction During Phacoemulsification With Posterior Chamber Intraocular Lens Implantation

67-year-old female who underwent phacoemulsification and posterior chamber intraocular lens (IOL) implantation and developed a rare fibrinous reaction intraoperatively. A fibrinous reaction was noticed at the end of surgery and was managed excellently This case report highlights the possible related mechanisms of such an event, such as disruption of the Blood-Aqueous Barrier (BAB), surgical trauma, and systemic disease. To reduce the risk of complications, close follow-up and prompt initiation of anti-inflammatory therapy are essential. Further studies are needed to investigate the predisposing factors to developing fibrinous reactions during cataract extraction.

King kahled eye specilasit hospital

comprehensive clinic 

A 67-year-old presented with a history of decreased vision in the right eye for the past few years. On examination, visual acuity was 20/400 in the right eye and 20/60 in the left eye. Both eyes had normal intraocular pressure, Slit-lamp examination of the right eye revealed a shallow anterior chamber. A white cataractous lens was visible with no view of the fundus. No retinal detachments or other pathologies were noted on B-scan ultrasonography. The patient underwent phacoemulsification and intraocular lens insertion in the right eye. Intra-operatively At  the end of an uncoplicated cataract surgury fibrinous reaction was noted. The main wound was sutured. Intracameral cefuroxime, triamcinolone, and sub-conjunctival decadron were injected. The patient was seen 2-3 hours post-operatively and showed no fibrous reaction. Visual acuity and IOP of the operative eye were 20/20- and 18-mm Hg on day one after surgery. On slit lamp examination, the anterior chamber showed +2 cells with no flare or fibrinous reaction—posterior capsular IOL in place with triamcinolone deposits on its surface. No unusual discomfort was reported. 

The patient was started on prednisolone acetate, moxifloxacin, and cyclopentolate. After a 6-week follow-up, the patient was seen in the clinic. The anterior chamber was deep and quiet with no cells or flare. The patient was happy with her vision.

Fibrinous reaction occurring immediately in the intraoperative period in an adult patient during cataract extraction is a rare event. we describe possible related factors responsible for the blood-aqueous breakdown in our study include surgical trauma and systemic disease. This case highlights the need for careful preoperative assessment and intraoperative monitoring to prevent, diagnose and treat such complications promptly. It is also essential to start anti-inflammatory therapy promptly to avoid further damage to the eye. Close follow-up of the patient is necessary to monitor the response to treatment. Further studies are needed to elucidate this condition's pathophysiology and identify the possible predisposing factors.