Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Cornea
Case 2
Patient presentation: A 58-year-old male patient with Fuchs' endothelial dystrophy was referred for evaluation of worsening vision. He underwent Descemet membrane endothelial keratoplasty (DMEK) in the right eye. At post-operative week 1, the patient reported foreign body sensation and “foggy” vision.
Anterior segment OCT (AS-OCT) was performed to evaluate the cornea and is shown below:
Question 1: What abnormal finding is demonstrated in this AS-OCT image?
Question 2: Which of the following is the most likely cause of microcystic edema in this patient?
Question 3: What is the first-line treatment for symptomatic microcystic corneal edema?
References
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Moshirfar M, Santos JM, Wang Q, et al. A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE). Cureus. 2023;15(8):e43926. Published 2023 Aug 22. doi:10.7759/cureus.43926
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Yi DH, Dana MR. Corneal edema after cataract surgery: incidence and etiology. Semin Ophthalmol. 2002;17(3-4):110-114. doi:10.1076/soph.17.3.110.14783
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Sharma N, Singhal D, Nair SP, Sahay P, Sreeshankar SS, Maharana PK. Corneal edema after phacoemulsification. Indian J Ophthalmol. 2017;65(12):1381-1389. doi:10.4103/ijo.IJO_871_17
Learning Objectives:
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Understand the imaging features of microcystic corneal edema, which include hypo-reflective subepithelial cysts on AS-OCT.
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Recognize that transient microcystic corneal edema may occur with surgical trauma.
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Recognize that topical hypertonic saline drops are used for reducing transient microcystic corneal edema.