Posters

Corneal ulcer following phacoemulsification in a patient with rheumatoid arthritis

Poster Details

First Author: I.Tarib MOROCCO

Co Author(s): M. Khamaily   J. Brahim Salem   S. Bajjouk   Y. Mouzarii   K. Reda   A. Oubaaz     

Abstract Details

Purpose:

To showcase a rare complication of phacoemulsification in a patient with dry eye disease and the importance of ocular surface treatment in cataract surgery.

Setting:

Military Teaching Hospital Mohammed V- Rabat, Morocco

Methods:

A 65 year old female was referred to our department for cataract surgery. Patient was treating for rheumatoid arthritis and dry eye disease for 5 years and reports decreased visual acuity for over a year in both eyes. Upon first examination, patient presents diffuse superficial punctuate keratitis (SPK) OU (OS>OD), and a nuclear cataract N2C3P2 in both eyes. Patient continued use of lubricants preoperatively with adjunction of vitamin A ointment and surgery of cataract of OD was scheduled for the following week. An uneventful 13 minutes long phacoemulsification was performed under continuous irrigation of BSS on the cornea.

Results:

Patient was implanted with a monofocal IOL and went home with an eye patch. Day one postoperative showed mild corneal edema and persistence of SPK, a treatment of low dose topical corticosteroids, antibiotics, lubricants, vitamin A, tropicamide and occlusion was prescribed. One week later, follow up finds an inferior central corneal sterile ulcer of 2*2.6mm surrounded by edema. Patient was given antibiotics and antiviral agents, therapeutic contact lens, conservative free artificial tears and intensive lubrication. Close surveillance with anterior segment OCT found a corneal thinning that improved over the course of 6 weeks with complete corneal re-epithelialization.

Conclusions:

Corneal ulcer following phacoemulsification is a rare occurence these days. Patients with rheumatoid arthritis usually present severe forms of dry eye disease and require meticulous ocular surface management before and after phacoemulsification. This case shows the importance of a quickly installed treatment plan to prevent devastating complications such as a corneal perforation, especially in our country, where access to keratoplasty is extremely limited and the waiting lists for a donor are quite long.

Financial Disclosure:

None