Persistent Epithelial Defect Due To Dry Eye Disease After Phacoemulsification Surgery

Cataract surgery is one of the most frequent and successful interventions currently. Small-incision surgery has excellent clinical outcomes coupled with rapid post-operative recovery and low risk of complications. Dry eye disease (DED) is one of the commonest complaints reported in ophthalmology clinics. There are many potentially DED-inducing factors both intraoperatively and postoperatively, also cataract surgery is a risk factor for DED. Platelet-rich plasma (PRP) can be defined as a volume of AS containing a platelet concentration over the basal level (150 000–350 000/μl).

We report a case of persistant epitelial defect with DED that developed after cataract surgery.

Hacettepe University Faculty of Medicine, Ankara, Turkey

A 66-year-old woman presented in September 2022 with a painless loss of vision of the right eye (RE). Trehalose and sodium hyaluronate eye drops were usen due to DED. She had Sjogren’s syndrome and she was followed by rheumatologists.Patient underwent routine phacoemulsification cataract surgery with intraocular lens (IOL) replacement under local anaesthesia. Post-operative recovery was uneventful and visual acuity was 6/6 in both eyes on 1st post-operative day but first day after cataract surgery, she presented with unilateral photophobia in normal vision. Upon examining her eyes cornea was clear with no congestion; there were no anterior chamber cells or hypopyon, therefore, the possibility of Toxic Anterior Segment Syndrome (TASS) or endophthalmitis was improbable. The vitreous was clear, with a flat retina in both eyes. Fluorescence staining of the cornea showed large epitelial defect near the main incison to the central cornea in right eye. She was diagnosed with persistant epithelial defect due to dry eye disease and treated with preservative-free ophthalmic ointment with theraloz and bandage contact lenses. But her cornea was not healed after this treatment so PRP was started 6 times a day with moxifloksasin drops. The patient's condition was finally best managed with PRP.  The patient had complete resolution of corneal epithelial defect with significant relief of symptoms at 1 week follow-up examinations.

The patient of this study has shown that persistent corneal epithelial defects can regress on using of PRP and it is probably due to DED after catarcat surgery that may probably account for this transient event. After phacoemulsification persistent epithealial defects can be seen due to DED. This form of epithelial defects could be persitent to the traditional treatments.