PDF
ePub
Citation
Print
Abstract
Purpose
To report two cases of toxic corneal reaction induced by infusion of distilled water into anterior chamber during cataract surgery.
Case summary
The first case was a 60-year-old female who was inadvertently infused with distilled water for 20 minutes during phacoemulsification in place of balanced salt solution (BSS). The second case was a 70-year-old male who received anterior chamber irrigation with distilled water for approximately 1 minute then and then immediately irrigated with BSS as soon as the mistake was identified. In both cases, topical 1% prednisolone acetate and 5% NaCl solution was immediately administered every hour as well as oral prednisolone at 1 mg/kg for one week after which the dose was slowly tapered. The first case completely returned to normal after 3 months, whereas the second case only requied 1 month to re-turn to pre-surgery conditions.
Conclusions
Patients who were exposed to distilled water within the anterior chamber resulted in corneal endothelial damage and corneal edema proportionate to the amount irrigated. However, The corneal edema gradually healed with treatment and eventually regained translucency without complications, completely.
References
1. Anderson NJ, Edelhauser HF. Toxicity of ocular surgical solutions. Int Ophthalmol Clin. 1999; 39:91–106.
2. Hyndiuk RA, Schultz RO. Overview of the corneal toxicity of surgical solutions and drugs: and clinical concepts in corneal edema. Lens Eye Toxic Res. 1992; 9:331–50.
3. Glasser DB, Edelhauser HF. Toxicity of surgical solutions. Int Ophthalmol Clin. 1989; 29:179–87.
4. Edelhauser HF, Gonnering R, Van Horn DL. Intraocular irrigating solutions. A comparative study of BSS Plus and lactated Ringer’s solution. Arch Ophthalmol. 1978; 96:516–20.
5. McDermott ML, Edelhauser HF, Hack HM, Langston RH. Ophthalmic irrigants: a current review and update. Ophthalmic Surg. 1988; 19:724–33.
6. Yoon KC, Lim DW, Yang KJ. Toxic corneal reaction induced by distilled water infused during cataract operation. J Korean Ophthalmol Soc. 2003; 44:1448–51.
7. Choi DW, Chung IY, Seo SW, Song JK. A case of anterior chamber irrigation with distilled water during cataract operation. J Korean Ophthalmol Soc. 2004; 45:328–32.
8. Edelhauser HF. The resiliency of the corneal endothelium to refractive and intraocular surgery. Cornea. 2000; 19:263–73.
Figure 1.
(A) Slit lamp photograph of the first case: On the postoperative day 1, the cornea presented severe stromal edema and Descemet’s folds from limbus to limbus. The anterior chamber and IOL could not be observed due to the corneal edema. (B) On postoperative week 1, the stromal edema and Descemet’s folds improved. The anterior chamber could be observed and mild inflammation in the anterior chamber was noted. (C) On postoperative week 2, most of the stromal edema resolved but diffuse mild Descemet’s folds still remained.
Figure 2.
(A) Slit lamp photograph of the second case. At postoperative day 1, the cornea showed moderate stromal edema and Descemet’s folds, especially, at the lower half of the cornea. The cells of the anterior chamber were not clearly visible due to cornea haze. (B) At the postoperative week 1, the corneal edema markedly decreased, but diffuse Descemet’s folds still remained. (C) At postoperative month 1, the cornea was completely clear.
XML Download