Manifestation of Corneal Wound Gap during Cataract Surgery: A Case Report

Case Report

J Ophthalmol & Vis Sci. 2022; 7(2): 1066.

Manifestation of Corneal Wound Gap during Cataract Surgery: A Case Report

Wang X1, Li Y1, Zhang C2,3 and Dang G1,2*

1Department of Ophthalmology, Jinan Mingshui Eye Hospital, Zhangqiu District, Jinan City, People’s Republic of China

2Department of Ophthalmology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Lixia District, Jinan City, People’s Republic of China

3State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Tianhe District, Guangzhou City, China

*Corresponding author: Guangfu Dang, Department of Ophthalmology, Jinan Mingshui Eye Hospital, Zhangqiu District, Jinan City, People’s Republic of China; Department of Ophthalmology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Lixia District, Jinan City, People’s Republic of China

Received: February 28, 2022; Accepted: March 19, 2022; Published: March 26, 2022

Abstract

Significance: Intraoperative AS-OCT showed great advantages in the treatment of the patient with traumatic cataract and corneal perforation, and could be used to real-time monitor the changes of corneal wound and the IOL position.

Purpose: To report the change of corneal wound in a patient with traumatic cataract and corneal perforation during the anterior segment-OCT-assisted (ASOCT- assisted) cataract surgery.

Case Presentation: A 48-year-old male patient, whose right eye was injured by a steel wire two months ago, presented with traumatic cataract and corneal perforation. When he was referred to our hospital, the corneal epithelium and part of anterior stroma at the laceration had healed. Therefore, the corneal laceration was not sutured, and AS-OCT was conducted to monitor the corneal laceration and assess the IOL position during cataract surgery. The laceration maintained closed, and no liquid leakage through corneal laceration was found throughout the surgical operation. IOL was placed into the capsular bag, and the visual acuity of the affected eye recovered to 3/10 postoperatively.

Conclusions: Intraoperative AS-OCT could be used to real-time monitor the changes of corneal wound and the IOL position, and showed a significant advantage in the treatment of the eye with traumatic cataract and corneal perforation

Keywords: AS-OCT; Cataract surgery; IOL

Introduction

The incidence of ocular trauma is common despite the anatomical and functional protective mechanisms of the eye from the orbital rim and reflex closure of the lids [1]. Open-globe injuries, a visually and economically devastating cause of vision loss, are estimated to affect 2.8 and 3.7 per 100,000 population annually according to previous studies from New Zealand and Singapore [2,3], and are often accompanied by traumatic cataract. For the patients with open-globe injuries and traumatic cataracts, the change of corneal wound during cataract surgery has not yet been reported.

Anterior segment optical coherence tomography (AS-OCT) is a tool used for assessing different anterior segment eye variables, having the advantage of contactless operation and high scanning speed and precision [4,5]. It could be used to obtain high-resolution anterior segment images in vivo, even in the eyes with corneal scars. In clinical practice, AS-OCT has been widely applied for the diagnosis and treatment of many ocular anterior segment diseases, such as primary angle closure glaucoma, ocular surface neoplasia, corneal dystrophies, and so on, and for improving the accuracy of intraocular lens (IOL) power calculations during cataract treatment [6]. Previous study reported that the operating microscope integrated intraoperative OCT could also be used for guiding cataract surgery and following up the changes of corneal wound [7]. Here we report a patient with traumatic cataract and corneal perforation, whose corneal wound was tracked in real time during cataract operation using a microscope integrated intraoperative OCT.

Case Presentation

A 48-year-old male, whose right eye was injured by a steel wire two months ago, was referred to the outpatient of The First Affiliated Hospital of Shandong First Medical University due to blurred vision in the affected eye. After injury, he went to a local hospital immediately, and the antibiotic eye drops were used. But the corneal laceration was not sutured at that time, and no other ophthalmological treatment was performed before visiting our hospital.

The visual acuity of the affected eye was hand movement. Slitlamp examination showed an about 4mm corneal laceration in the temporal side of the pupil, where the corneal tissue exhibited local nubecula and edema. Iris posterior synechia and white cataract could be observed (Figure 2A and 2B). The presence of intraocular foreign body was excluded by ocular B-scan ultrasound (Figure 2C and 2D) and CT examination (Data not shown). Angle closure at the upper and nasal sides could be found by UBM, and the inferior and temporal anterior chamber angle was narrow (Figure 3A and 3B). The anterior chamber was slightly shallow (Figure 3C). AS-OCT revealed a fullthickness laceration in the temporal side of the central cornea, but the corneal epithelium and part of anterior stroma at the laceration had healed when the patient was referred to our hospital. Furthermore, a membrane adhering to the posterior surface of corneal laceration was found (Figure 3D). However, what the membrane was and where the membrane was from were still not sure. We inferred that it might come from the capsule of the lens or the folded Descemet membrane.