November 2012 Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

Figure 1 shows the left cornea of an 86-year-old female patient with bullous keratopathy. The patient unfortunately developed a decompensating cornea following an uneventful cataract operation. The records did indicate that she had mild-to-moderate pre-operative guttata. Figure 2 shows a central large blister in cross-section that spontaneously ruptured in the office shortly after the photograph was taken. Her best-corrected vision was count fingers OS.

Most likely the cataract surgery stressed her already compromised corneal endothelium, which led to significant corneal swelling. The patient was prescribed Muro 128 5% ointment (Bausch + Lomb) b.i.d. OS, which is hypertonic, to reduce corneal swelling. She was prescribed Iquix (Vistakon Pharmaceuticals) q.i.d. OS to prevent infection of her compromised ocular surface. A bandage contact lens wasn't fit because the patient did not have significant pain.

The patient's corneal edema did not resolve, and she underwent a Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) procedure to replace her dysfunctional endothelium. Unfortunately this failed, and she eventually underwent a penetrating keratoplasty (PKP), which improved her vision to 20/80 OS.