Corneal Bullous Epithelial Detachment in Diabetic Cataract Surgery

Diabetic keratopathy is an ocular complication secondary to diabetes. Patients receiving ocular surgery have an increased risk for intraoperative and postoperative corneal complications, and the preexisting keratopathy aggravation may impact postoperative visual quality. We observed a rare case of corneal complication during cataract surgery and analyzed the possible pathogenesis and methods to avoid occurrence.

A 64-year-old male diabetic patient received routine phacoemulsification (phaco) in the right eye. After the phaco handpiece entered the anterior chamber and irrigation was begun, the corneal epithelium detached and a bleb was formed, expanding to the entire cornea, and then wrinkled along the limbus for the remainder of the surgery. On the first day postoperatively, diffuse corneal edema occurred with Descemet membrane striae, and the corneal epithelium detached on a large scale. Within 2 weeks, the cornea was clear with adherent epithelium and smooth Descemet membrane.

To our knowledge, intraoperative epithelial detachment during cataract surgery is rare. Because elevated glucose changes the normal corneal structure, surgery such as phaco might also cause unpredictable corneal lesions. To avoid this possibility, serum glucose control before surgery and careful performance during surgery are essential.