[Skip to Content]
[Skip to Content Landing]

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

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.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

Corneal edema after cataract surgery secondary to intraoperative Descemet membrane detachment (Figure 2)

C. Obtain an anterior-segment optical coherence tomogram

In cases of diffuse corneal edema, where visualization is limited, anterior-segment optical coherence tomography (AS-OCT) can help diagnose pathologies, such as Descemet membrane (DM) detachment (DMD) and/or retained lens fragments.

Immediate penetrating keratoplasty (choice A) is not recommended for localized endothelial pathology. Endothelial keratoplasty (choice D), would not be the first step without determining underlying pathology or trying less invasive procedures. Additional treatment with topical agents (choice B) would not be preferred as the patient experienced decreased vision despite 8 weeks of topical therapy.

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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.

References
1.
Yi  DH , Dana  MR .  Corneal edema after cataract surgery: incidence and etiology.   Semin Ophthalmol. 2002;17(3-4):110-114. doi:10.1076/soph.17.3.110.14783 PubMedGoogle ScholarCrossref
2.
Scheie  HG .  Stripping of Descemet’s membrane in cataract extraction.   Arch Ophthalmol. 1965;73:311-314. doi:10.1001/archopht.1965.00970030313003 PubMedGoogle ScholarCrossref
3.
Benatti  CA , Tsao  JZ , Afshari  NA .  Descemet membrane detachment during cataract surgery: etiology and management.   Curr Opin Ophthalmol. 2017;28(1):35-41. doi:10.1097/ICU.0000000000000332 PubMedGoogle ScholarCrossref
4.
Sharma  N , Singhal  D , Nair  SP , Sahay  P , Sreeshankar  SS , Maharana  PK .  Corneal edema after phacoemulsification.   Indian J Ophthalmol. 2017;65(12):1381-1389. doi:10.4103/ijo.IJO_871_17 PubMedGoogle ScholarCrossref
5.
Zhou  SY , Wang  CX , Cai  XY , Liu  YZ .  Anterior segment OCT-based diagnosis and management of Descemet’s membrane detachment.   Ophthalmologica. 2012;227(4):215-222. doi:10.1159/000334946 PubMedGoogle ScholarCrossref
6.
Mackool  RJ , Holtz  SJ .  Descemet membrane detachment.   Arch Ophthalmol. 1977;95(3):459-463. doi:10.1001/archopht.1977.04450030101014 PubMedGoogle ScholarCrossref
7.
Jacob  S , Agarwal  A , Chaudhry  P , Narasimhan  S , Chaudhry  VN .  A new clinico-tomographic classification and management algorithm for Descemet’s membrane detachment.   Cont Lens Anterior Eye. 2015;38(5):327-333. doi:10.1016/j.clae.2015.03.012 PubMedGoogle ScholarCrossref
8.
Sparks  GM .  Descemetopexy: surgical reattachment of stripped Descemet’s membrane.   Arch Ophthalmol. 1967;78(1):31-34. doi:10.1001/archopht.1967.00980030033006 PubMedGoogle ScholarCrossref
9.
Chaurasia  S , Ramappa  M , Garg  P .  Outcomes of air descemetopexy for Descemet membrane detachment after cataract surgery.   J Cataract Refract Surg. 2012;38(7):1134-1139. doi:10.1016/j.jcrs.2012.01.030PubMedGoogle ScholarCrossref
10.
Sharma  N , Gupta  S , Maharana  P , Shanmugam  P , Nagpal  R , Vajpayee  RB .  Anterior segment optical coherence tomography-guided management algorithm for descemet membrane detachment after intraocular surgery.   Cornea. 2015;34(9):1170-1174. doi:10.1097/ICO.0000000000000514PubMedGoogle ScholarCrossref
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close