Franch Antonella, Bini Silvia, Francescutti Lorena, Birattari Federica, Leon Pia, Bonamartini Daniele, Gambato Tommaso, Altafini Romeo
Ophthalmology Unit, Ospedale SS Giovanni e Paolo, ULSS 3 Serenissima, Venice, Italy.
Ophthalmology Unit, Presidio ospedaliero di Dolo, ULSS 3 Serenissima, Venice, Italy.
Case Rep Ophthalmol. 2023 Sep 26;14(1):484-490. doi: 10.1159/000533768. eCollection 2023 Jan-Dec.
We report a case series of 26 eyes of 26 patients undergoing planned cataract surgery from December 2021 to March 2022, who were diagnosed as having whitish round infiltrates in the surgical corneal incisions. The infiltrates were detected at the first check after 5-8 days from cataract surgery and were located either within the main corneal incision and/or in the smaller incisions. Corneal infiltrates (CIs) were single or multiple, without epithelial defects, and painless. All infiltrates were initially treated with full topical antibiotic coverage, in order to control eventual and serious postsurgical infection. However, at daily checks, the clinical course of CIs suggested a sterile etiology. For this reason, steroidal topical treatment was maintained for a long time with slow tapering until complete remission of the CIs. All infiltrates resolved completely in around 30-40 days. The surgical instruments and the sterilization process were scrutinized. A white amorphous material was found mainly on non-disposable anterior chamber cannulas and on irrigation/aspiration tips. Disposable cannulas were adopted, and machinery for cleaning and sterilization procedures were reviewed, with specific reference to water softener renewal. Thanks to these precautions, CIs never occurred again. Finally, our hypothesis was an immune corneal reaction to amorphous deposit on cannula tips. This case series describes a previously unknown complication of cataract surgery and our experience might be useful for other surgeons.
我们报告了一组病例，2021年12月至2022年3月期间，26例患者计划进行白内障手术，其26只眼睛在手术角膜切口中被诊断为有白色圆形浸润。浸润在白内障手术后5 - 8天的首次检查时被发现，位于主角膜切口内和/或较小的切口中。角膜浸润（CIs）为单发或多发，无上皮缺损，且无痛。所有浸润最初均采用全面的局部抗生素覆盖治疗，以控制可能出现的严重术后感染。然而，在每日检查中，CIs的临床过程提示为无菌性病因。因此，长期维持局部使用类固醇治疗并缓慢减量，直至CIs完全缓解。所有浸润在约30 - 40天内完全消退。对手术器械和灭菌过程进行了仔细检查。主要在非一次性前房插管和冲洗/抽吸尖端发现一种白色无定形物质。采用了一次性插管，并对清洁和灭菌程序的设备进行了审查，特别提及了水软化剂的更新。由于采取了这些预防措施，CIs再也没有发生。最后，我们的假设是角膜对插管尖端无定形沉积物的免疫反应。该病例系列描述了一种此前未知的白内障手术并发症，我们的经验可能对其他外科医生有用。
