Kim Seonghwan, Lee Jeong Hyun
Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, South Korea.
Case Rep Ophthalmol. 2024 Aug 22;15(1):656-662. doi: 10.1159/000540603. eCollection 2024 Jan-Dec.
Cataract surgery is one of the most commonly performed surgical procedures worldwide. Intraoperative and postoperative complications of cataract surgery include posterior capsule rupture, retinal detachment, suprachoroidal hemorrhage, cystoid macular edema, endophthalmitis, and intraocular lens dislocation. As corneal perforation is rarely related to cataract surgery, we report a case of intraoperative iatrogenic corneal puncture that led to a full-thickness laceration that was managed without severe complications.
An 81-year-old woman underwent immediate sequential bilateral cataract surgery. Cataract grading of both eyes was nuclear color grade II and cortical cataract grade III, according to the lens opacity classification system III. While performing cataract surgery on her right eye, a corneal puncture with a keratome incidentally occurred just before making the main temporal incision, resulting in a 3-mm full-thickness laceration at the peripheral cornea. One-bite of 10-0 nylon suture was placed, and the remaining procedure was performed through a superior main incision. Three-bites of 10-0 nylon suture were placed at the laceration site at the end of the procedure. The uncorrected visual acuity was 20/40 in both eyes the following day. Corneal astigmatism increased in the right eye, and the refractive error was more myopic than targeted. No leakage was observed.
Slight corneal contact with a keratome can lead to full-thickness laceration when the anterior chamber is filled with an ophthalmic viscosurgical device during cataract surgery. Caution should be exercised while manipulating sharp surgical instruments to avoid such complications.
白内障手术是全球最常开展的外科手术之一。白内障手术的术中及术后并发症包括后囊破裂、视网膜脱离、脉络膜上腔出血、黄斑囊样水肿、眼内炎和人工晶状体脱位。由于角膜穿孔很少与白内障手术相关，我们报告一例术中医源性角膜穿刺导致全层撕裂伤的病例，该病例经处理后未出现严重并发症。
一名81岁女性接受了双眼即刻连续白内障手术。根据晶状体混浊分类系统III，双眼白内障分级均为核颜色II级和皮质白内障III级。在为其右眼进行白内障手术时，就在制作颞侧主切口之前，意外发生了角膜刀穿刺角膜的情况，导致周边角膜出现3毫米的全层撕裂伤。放置了一针10-0尼龙缝线，其余手术通过上方主切口进行。手术结束时在撕裂伤部位放置了三针10-0尼龙缝线。术后第二天双眼未矫正视力均为20/40。右眼角膜散光增加，屈光不正比预期更近视。未观察到渗漏。
在白内障手术中，当前房充满眼科粘弹剂时，角膜刀与角膜的轻微接触可导致全层撕裂伤。在操作锐利的手术器械时应谨慎，以避免此类并发症。
