Post operative Corneal Edema
Stromal and/or epithelial edema due to multiple etiologies may occur throughout the postoperative period
Edema due to surgical trauma, acute endothelial decompensation from under lying dystrophy, and epithelial edema due to elevated IOPm ay be seen early
Toxic substances inadvertently introduced into the AC can also cause early diffuse corneal edema, referred to as toxic anterior segment syndrome (TASS)
Late postoperative inferior corneal edema may occur because of small nuclear
fragments retained in the anterior chamber angle
These fragments may be noticed on initial postoperative examinations or identified up to years later if they migrate into the AC from PC
Vitreocorneal touch may contribute to persistent corneal edema after cataract surgery complicated by vitreous prolapse
Significant chronic corneal edema from loss of endothelial cells results in bullous keratopathy
MANAGEMENT
In the early stages: Managed with topical hypertonic eyedrops, corticosteroids, and aqueous suppressants
Edema from surgical trauma generally resolves completely within 4–6 weeks
When epithelial edema is due to elevated IOP, lowering the pressure medically or via aqueous release from the paracentesis site often results in rapid resolution
Removing all vitreous from the anterior chamber during complicated cataract surgery decreases the risks of corneal edema as well as CME and RD
When vitreous prolapse with corneal touch or incarceration in the wound is recognized post-operatively and corneal edema or CME develops, anterior vitrectomy with removal of vitreous from the incision or Nd:YAG laser vitreolysis may be indicated
In more advanced cases with prolonged corneal edema, keratoplasty combined with vitrectomy may be indicated
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Image from Rajan Eye Care Hospital
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