Acute Corneal Melting After Phacoemulsification Corneal Wound

To report a rare case of corneal melting as complication of phacoemulsification corneal wound burn and to raise awareness about this complication that can result from a routine cataract surgical as well as the topical medication and diseases that can contribute to this.

We present an 85-year-old man with clinical history of Diabetes and Hypertension who underwent a phacoemulsification cataract surgery through a 2.75 mm corneal incision. A foldable intraocular lens was implanted and single corneal suture using 10/0 monofilament was placed on the main incision. Postoperative treatment included ofloxacin and dexamethasone 4 times daily each one. On the first postoperative day, corneal wound burn on the main incision and a Positive Seidel Test were evidenced, a contact lens was placed, next day adequate wound sealing was evidenced and Diclofenac sodium was added 3 times daily. One week after surgery the patient presented to the emergency department with blurred vision and mild eye pain. A sterile corneal melting around the main incision with a Positive Seidel Test were found, immediately underwent surgery where a corneal suture was performed and after the removal of friable cornea, a perforation area of 2 mm far from the incision was evidenced. Therefore, a tectonic drape patch was attached with cyanoacrylate glue. The procedure was successful. At one month follow up the patient is recovering with no signs of inflammation or corneal melting.

Corneal incision contracture commonly known as cornea wound burn, is an uncommon but potentially serious complication of cataract surgery, associated with sequels such as corneal melting, for that reason every ophthalmologist should be more aware about this potential complication. Moreover, in this case report corneal melting can be associated with use of  topical non-steroidal antiinflamatory drugs (NSAID) and Diabetes.Therefore,is important to remember that an adequate technique which uses less ultrasound energy should be performed as prevention to reduce corneal wound burn.Furthermore the identification of conditions that rise the risk of corneal melting is clinically essential as well as an appropriate follow-up  when NSAID are used.