Misdiagnosed Corneal Decompensation After Cataract Surgery: The Role Of Elevated Iop And Microsecond Pulse Cyclophotocoagulation In Visual Recovery

Corneal edema after cataract surgery resulting from elevated intraocular pressure (IOP) is frequently mistaken for corneal decompensation, potentially leading to unnecessary interventions. Prompt and accurate management in such cases is essential for optimal visual recovery. Microsecond pulse transscleral cyclophotocoagulation (µCPC) has emerged as a minimally invasive procedure to effectively reduce IOP in various glaucomatous conditions.

Purpose of this study is to present a series of cases where patients, initially misdiagnosed with corneal failure after cataract surgery, were found to have corneal edema secondary to elevated IOP. These cases were successfully managed with µCPC.

Study was performed at the department of ophthalmology of International Clinic, Orhei, Republic of Moldova in 2024.

A retrospective review was conducted on patients who developed corneal edema after cataract surgery and were referred with a diagnosis of corneal decompensation. Comprehensive ophthalmic evaluations, including slit-lamp examination, corneal pachymetry, and IOP measurements, were performed. Patients diagnosed with IOP-induced corneal edema underwent µCPC using the FOX diode laser, 810 m (A.R.C. Laser, Nuremberg, Germany). The procedure parameters included a power setting of 2,0 W; pulse duration 500 µs, pulse pause 1 ms, resulting in duty cycle of 33,3%. In total 107 to 120 J (laser time 160 – 180 s) were applied to the eye, covering 300 degrees of the ciliary body, avoiding the 3 and 9 o'clock positions.

Five patients (3 males, 2 females; age range: 65–78 years) were included. All presented with corneal edema unresponsive to standard medical therapy and were initially considered for corneal transplantation. Elevated IOP (range: 28-40 mmHg) was identified as the underlying cause. Best corrected visual acuity (BCVA) ranged from hand motion to counting fingers. Following µCPC, a significant reduction in IOP was observed in all cases (mean reduction: 40%), with IOP levels stabilizing within the target range. Corneal edema resolved within 2–4 weeks post-procedure and BCVA improved to pre-edema levels (0,4+0,2). No significant complications, such as hypotony or persistent inflammation, were noted during the follow-up period (mean: 8 months).

Elevated IOP should be considered in the differential diagnosis of corneal edema following cataract surgery to prevent misdiagnosis and unnecessary surgical interventions. µCPC is an effective and safe treatment modality for managing IOP-induced corneal edema, leading to the resolution of edema and restoration of visual function. Early recognition and appropriate management of elevated IOP can prevent irreversible corneal damage and improve patient outcomes.