目的:报告1例白内障手术后由于前房晶状体碎片残留导致晚发性角膜代偿失调的病例。
方法:一名65岁女性,自4个月以来一直抱怨左眼视力逐渐变暗。4年前,她在其他地方进行了顺利的超声乳化和后房型人工晶状体植入术。在检查中,左眼CDVA为20/200。裂隙灯检查显示角膜水肿并伴有Descemet\'s褶皱。她被诊断为假晶状体大疱性角膜病变,正在接受局部类固醇治疗,同样的环麻痹和高渗剂。她还接受了板层角膜移植的建议。后段检查在正常范围内。由于IOL的位置(沟与袋)没有清楚地看到超声生物显微镜(UBM)和前节光学相干断层扫描(AS-OCT)成像,以尝试更好地了解角膜代偿失调的可能原因。令我们惊讶的是,两者,UBM和ASOCT,一个人,保留的晶状体碎片在60时在前房中发现。进行AC洗涤以除去保留的晶状体碎片。AC冲洗后3个月角膜水肿完全消退,BCVA改善至20/40。
结论:和重要性:这个案例强调了全面的临床评估的重要性,辅以影像学检查,以便做出完整的诊断并最终为患者取得更好的结果。在任何原因不明的角膜水肿的情况下,无论是术后早期还是术后晚期,UBM和ASOCT对确定根本原因非常有帮助。
OBJECTIVE: To report a case of late onset corneal decompensation following cataract surgery due to retained lens fragment in anterior chamber.
METHODS: A 65 year old female presented with complaint of gradual dimness of vision in left eye since 4 months. She underwent uneventful phacoemulsification with posterior chamber intraocular lens implantation elsewhere 4 years back. On examination, the CDVA in left eye was 20/200. Slit-lamp examination revealed corneal edema with Descemet\'s folds. She was diagnosed as pseudophakic bullous keratopathy and was being treated with topical steroids, cycloplegics and hyperosmolar agents for the same. She was also counseled about a lamellar corneal transplant. Posterior segment examination was within normal limits. Since the position of the IOL (sulcus versus bag) was not clearly seen ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) imaging was performed to try and better understand the possible cause for corneal decompensation. To our surprise, on both, UBM and ASOCT, a single, retained lens fragment was noted at 6 0\'clock in the anterior chamber. AC wash was performed to remove the retained lens fragment. 3 months post AC wash corneal edema resolved completely with improvement in the BCVA to 20/40.
CONCLUSIONS: AND IMPORTANCE: This case highlights the importance of a thorough clinical evaluation supplemented with imaging modalities in order to make a complete diagnosis and eventually achieve better outcomes for the patient. In any case of unexplained corneal edema, either in the early or late postoperative period, UBM and ASOCT can become very helpful to determine the underlying cause.