Diagnostic use of anterior segment OCT to detect retained lens fragment following cataract surgery

Poster Details

First Author: F.Shahid UK

Co Author(s):    J. Gandhewar   V. Savant           

Abstract Details

Purpose:

To describe a case where early evaluation with anterior segment OCT has proven to be of diagnostic benefit in a patient presenting with intermittent corneal oedema.

Setting:

A 79 year female presented to the eye casualty with a painful red right eye and reduced vision. She had undergone an uneventful cataract surgery six months ago. Visual acuity at presentation was OD 6/18, OS 6/9. Examination showed central corneal oedema but no anterior chamber activity. Treatment with topical dexamethasone 0.1 % helped in resolving the corneal oedema.

Methods:

However, the patient re-presented to eye casualty two months later with similar complaints. Examination showed visual acuities of OD 6/12, OS 6/9; slit lamp examination revealed inferior and central corneal oedema. An anterior segment OCT was performed which demonstrated a retained epi-nuclear fragment in the anterior chamber inferior angle, responsible for the corneal oedema. The patient underwent anterior chamber epi-nuclear fragment removal. The vision in her right eye improved following surgery to 6/7.5.

Results:

Following cataract surgery, retained nuclear fragments in the anterior segment may cause persistent postoperative inflammation and corneal oedema. The onset of corneal oedema after a cataract surgery can vary in time and up to 15 years has been reported. Retained nuclear fragments in the anterior chamber can cause significant corneal oedema and reduced vision that can be reversed by removing the fragments.

Conclusions:

This case highlights the usefulness of prompt anterior segment OCT allowing visualisation of the entire angle to ascertain whether there is a single or multiple lens fragment causing insult to the cornea. This can inevitably reduce the time taken for surgical treatment thus avoiding prolonged medical treatment which may well be refractory. Ultimately better visual prognosis can be achieved by treating the cause of corneal oedema imminently. To our knowledge there have been no descriptions of using anterior segment OCT in cases of retained lens fragment causing intermittent corneal oedema. FINANCIAL DISCLOSURE?: No