Cataract Surgery in a Case of Bilateral Idiopathic Corneal Ascher Rings Associated With Anterior Segment Changes

The aim of this study is to report 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 patient bilateral and symmetrical corneal ring opacities, within the full stromal thickness, with gray-whitish appearance and ellipsoid shape; diameters were 4-6 mm, clear central/peripheral cornea; no other corneal structural changes were identified via anterior segment optical coherence tomography (AS-OCT). Specular microscopy parameters, including pachymetry, were unremarkable. Such corneal changes could not be classified as sequelae 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. By exclusion, the corneal opacities were classified as Ascher rings. Cataract surgery was uneventful, with excellent recovery. IOL power calculation reflected the axial anysometropia (21.5D in OD, respectively, 15D in OS-Clareon SY60WF, Alcon), as well as asymmetric gonioscopy findings.

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 have not been reported in any previous cases from literature.