Late onset corneal oedema in pseudophakia and the concept of “blooming” with intraocular lens injectors

You have full access to this article via your institution. Download PDF TO THE EDITOR: Once the balance between the physiological processes of the cornea is disrupted by mechanical,

infective, inflammatory or toxic aetiologies, corneal oedema ensues [1, 2]. Delayed onset corneal oedema in a pseudophakic patient can have several infective and inflammatory aetiologies,

however, retained intraocular foreign body should be considered. Figure 1a illustrates inferonasal epithelial and stromal oedema encroaching onto the visual axis in the left eye of an 84

year old pseudophakic patient, which did not present until six months after uncomplicated cataract surgery. The working diagnosis prior to referral to us was viral keratitis, but treatment

for this did not cause resolution of the corneal oedema. At referral, the patient’s vision was counting fingers, and there were no corneal findings suggestive of inflammation. Gonioscopy

revealed a foreign body in the inferior iridocorneal angle (Fig. 1b). It was removed under local anaesthetic and sent for histopathological assessment and found to be non-organic (Fig. 1c).

The corneal oedema resolved post operatively. We believe that the haptic of the Akreos MI60L intraocular lens (IOL) (Baush and Lomb, New Jersey, USA) became fractured at the optic haptic

junction, and dislodged intraoperatively during the IOL insertion process with a Visco-jet BIO 2.2 injector (Medicel, AG, Switzerland). The process of ‘blooming’ (legal manufacturer personal

communication), where the plunger overrides the lens, contributes to fracture at the optic haptic junction, with the haptic becoming trapped between the cartridge and the plunger (Fig. 1d,

not from this case). If the plunger is retracted before the cartridge is removed from the eye, the haptic may be dislodged into the anterior chamber, and lodge in the angle. There have been

reports of haptic retention in the anterior chamber angle, where lens exchange had to be performed intraoperatively or delayed [3,4,5]. The IOL in this case was not noted to be decentred,

but appeared supported by the rest of the three plate haptics. Peripheral anterior capsular opacification did not allow for the haptics to be visualized in the bag. Blooming provides a

mechanism for fractured haptics in uncomplicated cataract surgery when using the MI60 lens. It is important to ensure that the plate haptics are intact and the lens is in position after

insertion particularly when ‘blooming’ is noted. REFERENCES * Cogan D. Corneal edema: introduction. Int Ophthalmol Clin. 1968;8:523–6. CAS  PubMed  Google Scholar  * Costagliola C, Romano V,

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decompensation after pseudophakic IOL exchange. J Cataract Refract Surg. 2004;30:1362–5. Article  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department

of Ophthalmology, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG72UH, UK Michelle S. Attzs, Bansri K. Lakhani & Veerabahu S. Maharajan * Department of

Ophthalmology, Sherwood Forest Hospitals NHS Foundation Trust, King’s Mill Hospital, Mansfield Road, Sutton-in-Ashfield, NG17 4JL, UK Delicia Jayakumar Authors * Michelle S. Attzs View

author publications You can also search for this author inPubMed Google Scholar * Bansri K. Lakhani View author publications You can also search for this author inPubMed Google Scholar *

Delicia Jayakumar View author publications You can also search for this author inPubMed Google Scholar * Veerabahu S. Maharajan View author publications You can also search for this author

inPubMed Google Scholar CONTRIBUTIONS MA, BL, DJ and VSM all contributed equally to the formation of this manuscript, and were involved at each stage of its development. CORRESPONDING AUTHOR

Correspondence to Michelle S. Attzs. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains

neutral with regard to jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Attzs,

M.S., Lakhani, B.K., Jayakumar, D. _et al._ Late onset corneal oedema in pseudophakia and the concept of “blooming” with intraocular lens injectors. _Eye_ 36, 2221–2222 (2022).

https://doi.org/10.1038/s41433-022-02014-5 Download citation * Received: 22 January 2022 * Revised: 15 February 2022 * Accepted: 25 February 2022 * Published: 12 March 2022 * Issue Date:

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