What Does Corneal Edema That Does Not Go Away 6 Weeks After Cataract Surgery Mean?

Corneal edema is a common postoperative complication following cataract surgery, particularly phacoemulsification. This condition arises due to various factors that compromise the integrity and function of the corneal endothelium, which plays a crucial role in maintaining corneal transparency by regulating fluid balance (1).One of the primary causes of corneal edema post-cataract surgery is the mechanical trauma inflicted on the corneal endothelium during the surgical procedure.In summary, corneal edema after cataract surgery is a multifactorial condition arising from mechanical trauma, inflammation, retained lens fragments, and changes in intraocular pressure. 

A 70-year-old male patient presented to our ophthalmology clinic with a history of recurrent redness and significant pain in his left eye. The patient reported undergoing cataract surgery in the left eye six weeks prior, with persistent tenderness since the day of the procedure. He had previously undergone cataract surgery in his right eye approximately ten years earlier. There was no reported history of ocular trauma or any ocular surgeries aside from the cataract procedures. 

Upon initial examination, visual acuity was measured at 0.9 in the right eye (OD) and 0.2 in the left eye (OS) using a Snellen visual acuity chart. Intraocular pressure (IOP) readings were 15 mmHg OD and 17 mmHg OS, as determined by a non-contact tonometer (NCT). A slit lamp examination of the left eye revealed grade 1 and 2 anterior chamber (AC) reactions characterized by flare and severe corneal edema.Notably, a small whitish fragment, previously identified as hypopyon at the private clinic, was observed in the inferior aspect of the AC. Following dilation with mydriatics, a retained lens fragment was identified within the superior capsule.B-ultrasonography did not reveal any significant abnormalities.

Surgical intervention was performed on the left eye under local anesthesia. A clear corneal incision was made at the superior cornea, and hyaluronate sodium (13.8 mg/0.6 mL/SYR, Healon 5 inj; Meditip Co., Seoul, Korea) was injected into the anterior chamber. The lens fragment was successfully removed using lens forceps, and any residual hyaluronate sodium was cleared through irrigation and aspiration (Stellaris Vision Enhancement System; Bausch & Lomb, Rochester, NY, USA). On the first postoperative day, corneal edema in the left eye showed slight aggravation, with visual acuity limited to a finger count at 10 cm. IOP measured at 15 mmHg.

A follow-up examination one month postoperatively revealed further reduction in corneal edema and an improvement in visual acuity to 0.7 on the Snellen visual acuity chart.Postoperative anterior segment inflammation following cataract surgery presents a complex challenge in both diagnosis and management.Late-onset postoperative inflammation can result from several factors, including retained lens fragments, reactivated uveitis, and infections such as endophthalmitis and wound abscess (2). Additionally, the late development of corneal edema after cataract surgery has been associated with retained lens fragments (2–3), intraocular lens fragments (4), and endothelium (5).