Corneal Ascher Rings – Rare, Bilateral Finding During Cataract Surgery

We report hereby an extremely rare case of corneal annular opacities, incidentally found in a patient referred for age related cataract surgery. Additional anterior segment particularities were detected in this patient.

Clinical and imaging methods were employed for a rigorous ophthalmological examination; a full systemic check-up has been included in the investigation panel, as well

Examinations revealed in a 69 year old female bilateral and symmetrical corneal ring opacities, within the full stromal thickness, with grey-whitish appearance and elipsoid shape; diameters were 4/6mm, clear central/peripheral cornea; no other corneal structural changes were identified via anterior segment optical coherence tomography (AS-OCT). Specular microscopy parameters, pachymetry, corneal topography were unremarkable. Such corneal changes could not be classified as sequellas of infectious keratitis, corneal dystrophies or degenerations. Systemic pathologies have been also excluded; existent high blood pressure (HBP) and hypercholesterolemia could not be linked to such corneal findings in our patient. Per exclusion, the corneal opacities were classified as Ascher rings. Cataract surgery was uneventful, with excellent bilateral recovery (BCVA OU=1,sc). IOL power calculation (IOL Master) reflected the axial anysometropia (21.5D in OD, respectively 15D in OS - Clareon® SY60WF,Alcon), as well as asymmetric gonioscopy findings in anterior chamber angle opening. No changes in the endothelial cells count, in both eyes had been noted at 1 year folow up visit.

Cataract surgery performed in the presence of Ascher corneal rings alone, does not pose additional risks during phacoemulsification or postoperative intervals. However association with anterior segment changes (narrow anterior chamber angle, axial anysometropia) might raise additional surgical concerns, though unrelated to the rare corneal findings. These associations with such anterior segment changes have not been reported in previous cases from literature.