Posters

Advanced bullous keratopathy due to anterior chamber intraocular lens. 'The great bullae'

Poster Details

First Author: M.Puzo SPAIN

Co Author(s):    C. Porcar Plana   J. Sanchez Monroy   M. Romero Sanz   M. Vicente Altabas   M. Bakkali El Bakkali   A. Sanchez Perez     

Abstract Details

Purpose:

To report a case of a patient who attended the emergency department (ED) due to eye discomfort (rubbing sensation) and decreased visual acuity (VA) in his right eye (OD) in recent months.

Setting:

Ophthalmology department, Hospital Universitario Miguel Servet, Zaragoza, Spain.

Methods:

As background, he highlighted an ocular trauma in OD that required cataract surgery 37 years ago, associated with vitrectomy and cerclage. Best corrected VA remained 0,4 since surgery. In the ED examination, VA was 0.1, anterior pole biomicroscopy (BMC) showed corneal decompensation with a large central-inferior epithelial detachment, diffuse corneal edema, deep anterior chamber, with well-positioned intraocular lens, Tyndall-, and mild conjunctival hyperemia. The intraocular pressure (IOP) was normal. Following complementary tests were performed: pachymetry (measured above the bulla): 766 microns, endothelial count: not feasible due to severe edema, anterior pole tomography (OCT): corneal thickening and center-inferior epithelial-stromal detachment area.

Results:

After exploration, a therapeutic contact lens was adapted, and topical treatment consisting of antibiotic every 12 hours, anti-edema eye drops every 8 hours, and artificial tears on demand was applied. Next examination was as follows: VA was 0.2, BMC showed a well-adapted contact lens that was removed for the examination, corneal edema similar to the previous exploration, with Descemet folds, and disappearance of the epithelial bulla, with minimal remaining epithelial detachment. Due to patient's condition (suffering from visual loss and significant discomfort), a surgical option that would restore the corneal transparency and avoid future discomfort was offered. Endothelial damage caused by the anterior chamber IOL was considered the most probable cause of this corneal decompensation, so lamellar keratoplasties (DMEK or DSAEK) were discarded due to the need for a lens explant, and the difficulty of maintaining the air bubble required in these surgeries (previous vitrectomy). He was therefore included in the waiting list for penetrating keratoplasty + anterior chamber IOL explant and Worst retro pupillary lens implant. The patient is currently on the surgical waiting list.

Conclusions:

Although most cases occur after cataract surgery, in our case, this does not seem to have been the trigger. We rather think that damage was caused mechanically by the lens that the patient has implanted in the anterior chamber. It is necessary to emphasize the importance of monitoring and control patients with anterior camera lenses, as the lens itself, and the situation that requires its implantation, turns these eyes into risky eyes.

Financial Disclosure:

None