Decompensated cornea with epithelial and stromal edema

Area of Science:

• Ophthalmology
• Corneal Surgery
• Intraocular Lens Implantation

Background:

• A 66-year-old patient with a history of congenital cataract surgery and secondary anterior chamber intraocular lens (AC IOL) implantation developed corneal decompensation in the left eye.
• The patient had previously experienced retinal detachments in both eyes following AC IOL placement.

Observation:

• The left eye's AC IOL haptic was in contact with the cornea and entrapped within an extensive iridocorneal synechia, causing pupillary distortion and corneal edema.
• Corneal assessment revealed significant edema (central corneal thickness 775 μm) and unobtainable endothelial cell count, contrasting with the right eye's clear cornea and normal parameters.
• Optical coherence tomography confirmed the iridocorneal synechia and the deeply embedded haptic, alongside significant Soemmerring's ring formation.

Findings:

• The corneal decompensation in the left eye was directly attributed to the mechanical interaction between the AC IOL haptic and the cornea, exacerbated by the iridocorneal synechia.
• Surgical rehabilitation of the left eye requires addressing both the corneal pathology and the malpositioned AC IOL.

Implications:

• This case highlights the potential long-term complications of angle-fixated AC IOLs, particularly haptic-induced corneal issues and the challenges in managing secondary complications.
• Effective surgical strategies are crucial for restoring vision and corneal integrity in such complex cases, necessitating careful consideration of combined corneal and IOL procedures.