[Skip to Content]

Quiz

Cornea

Nonclearing Corneal Edema After Phacoemulsification and Intraocular Lens Implantation

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Ophthalmology

Published Online: February 11, 2021

JAMA Ophthalmology Clinical Challenge

Article Information and Disclosures

Shruti Aggarwal, MD¹;

Ghada Al Bayyat, MD¹;

Carol L. Karp, MD¹

Author Affiliations

¹Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida

Read article on JAMA Network

Read Case Take Quiz Answer

An 82-year-old man with an ocular history significant for bilateral nuclear sclerotic cataracts presented to the Cornea Service at Bascom Palmer Eye Institute, Miami, Florida, with a history of blurred vision in the right eye after phacoemulsification cataract extraction 8 weeks earlier. Current ophthalmic medications included topical prednisolone acetate, 1%, in the right eye 6 times per day. The patient reported no improvement with the treatment. On examination, his best-corrected visual acuity was 20/80 OD and 20/20 OS. Pupils were reactive without relative afferent pupillary defect, and intraocular pressures were 18 mm Hg in the right eye and 11 mm Hg in the left eye. A slitlamp biomicroscopic examination of the right eye revealed grade 2 to 3 diffuse central corneal edema and folds (Figure 1). The anterior chamber was deep and the posterior chamber intraocular lens was in good position within the capsular bag. Although the view to the posterior pole of the right eye was hazy owing to corneal edema, dilated fundus examination findings were unremarkable. Examination of the left eye revealed a few guttate. The central corneal thickness by ultrasound pachymetry was 957 μm in the right eye and 547 μm in the left eye.

Take Quiz

Please finish quiz first before checking answer.

An 82-year-old man with an ocular history significant for bilateral nuclear sclerotic cataracts presented to the Cornea Service at Bascom Palmer Eye Institute, Miami, Florida, with a history of blurred vision in the right eye after phacoemulsification cataract extraction 8 weeks earlier. Current ophthalmic medications included topical prednisolone acetate, 1%, in the right eye 6 times per day. The patient reported no improvement with the treatment. On examination, his best-corrected visual acuity was 20/80 OD and 20/20 OS. Pupils were reactive without relative afferent pupillary defect, and intraocular pressures were 18 mm Hg in the right eye and 11 mm Hg in the left eye. A slitlamp biomicroscopic examination of the right eye revealed grade 2 to 3 diffuse central corneal edema and folds (Figure 1). The anterior chamber was deep and the posterior chamber intraocular lens was in good position within the capsular bag. Although the view to the posterior pole of the right eye was hazy owing to corneal edema, dilated fundus examination findings were unremarkable. Examination of the left eye revealed a few guttate. The central corneal thickness by ultrasound pachymetry was 957 μm in the right eye and 547 μm in the left eye.

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Corresponding Author: Carol L. Karp, MD, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 (ckarp@med.miami.edu).

Published Online: February 11, 2021. doi:10.1001/jamaophthalmol.2020.4660

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by Center Core Grant P30EY014801 from the National Institutes of Health, a Research to Prevent Blindness Unrestricted Award, the Dr Ronald and Alicia Lepke Grant, the Lee and Claire Hager Grant, the H. Scott Huizenga Grant, Grant and Diana Stanton-Thornbrough, the Robert Baer Family Grant, the Emilyn Page and Mark Feldberg Grant, the Jose Ferreira de Melo Grant, the Richard and Kathy Lesser Grant, the Robert and Virginia Farr Grant, the Michele and Ted Kaplan Grant, and the Richard Azar Family Grant (institutional grants).

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the patient for granting permission to publish this information.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.