Corneal Swelling Following Cataract Surgery

Disease Name

Pseudophakic corneal edema. Also called pseudophakic bullous keratopathy. 

Definition

Persistent corneal edema after cataract surgery. All cataract surgery (even “perfect” surgery) does some damage to the corneal endothelial cells that are required to keep the cornea clear. Most corneas have plenty of “extra” endothelial cells, so a small degree of endothelial cell loss from cataract surgery doesn’t usually cause any problem. However, occasionally, after cataract surgery, the endothelial cells don’t function well enough to keep the cornea clear, causing poor vision and often discomfort. The cells may recover over the first few months after surgery.

Symptoms

Poor vision after cataract surgery, often worse in the morning, improving throughout the day.

Causes

Damage to the endothelial cells during cataract surgery.

Risk Factors

Fuchs dystrophy, prior ocular surgery. 

Complications

Corneal scarring, painful corneal bullae (blisters). 

Tests and Diagnosis

Slit lamp examination is essential. Corneal thickness testing (pachymetry). Imaging of the corneal endothelial cells with specular microscopy may be helpful.

Treatment

Treatment options include 5% saline drops and/or ointment to decrease swelling. Blowing cool or warm (not hot) air from a blow dryer upon awaking can often improve vision earlier in the day. Later, corneal transplantation, either a partial thickness endothelial transplant (e.g. Descemet’s stripping endothelial keratoplasty [DSEK] or Descemet’s membrane endothelial keratoplasty [DMEK]) or a full thickness corneal transplant. 

Prevention

Medical treatment may prevent or delay the onset or corneal haze. Endothelial keratoplasty is more successful in eyes with minimal to no corneal haze. In eyes with significant corneal scarring, a full thickness corneal may be required to achieve good vision.