Journal List > J Korean Ophthalmol Soc > v.52(4) > 1009022

Lee, Lee, and Kim: Two Cases of Corneal Edema Caused by Distilled Water during Cataract Surgery



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.


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.


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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.
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