J Korean Ophthalmol Soc.  2017 Jun;58(6):725-730. 10.3341/jkos.2017.58.6.725.

A Case of a Corneal Stromal Penetrating Injury via an Ejected Needle during Stromal Hydration

• Kim JE
• Lee MW

• KMID: 2382683
• DOI: http://doi.org/10.3341/jkos.2017.58.6.725

Abstract

PURPOSE
We report a case of a horizontally penetrating injury of corneal stroma via an ejected irrigating needle during stromal hydration in cataract surgery.
CASE SUMMARY
A 79-year-old woman presented with decreased visual acuity in her right eye. Her best corrected visual acuity in the right eye was 0.3. The cataract score of her right eye was nuclear opacity 3, cortical opacity 1−2, and posterior subcapsular opacity 1. She underwent phacoemulsification using a clear corneal approach while under topical anesthesia, and an intraocular lens was successfully implanted in the bag. A plastic syringe with an irrigating needle was used to hydrate the corneal stroma at the clear cornea site. As a result of the increased pressure applied to the connection between the syringe and irrigating needle, the loosened irrigating needle was forcefully ejected toward the corneal endothelium, horizontally penetrating the stroma without injuring the corneal epithelium. On the 1st postoperative day, her right eye exhibited a visual acuity of 0.5, astigmatism of −1.25 diopter (D) cyl., corneal edema with Descemet's folds, and insignificant scarring of the corneal endothelium. Three weeks after surgery, the visual acuity was 0.9, the astigmatism was −0.50 D, and any other abnormalities such as corneal opacity were no longer present.
CONCLUSIONS
Despite a penetrating needle injury through the corneal endothelium and stroma, the corneal wound healing process did not result in corneal opacity or worsened astigmatism. To prevent sequela due to an ejected irrigating needle, operators and assistants should be actively aware of tight locking between the needle and syringe.

Keyword

Corneal opacity; Corneal wound healing; Irrigating needle injury

MeSH Terms

Aged
Anesthesia
Astigmatism
Cataract
Cicatrix
Cornea
Corneal Edema
Corneal Opacity
Corneal Stroma
Endothelium, Corneal
Epithelium, Corneal
Female
Humans
Lenses, Intraocular
Needles*
Phacoemulsification
Plastics
Syringes
Visual Acuity
Wound Healing
Plastics

Figure

• 

  Figure 1 In process of hydration of corneal stroma during cataract surgery, the loosed irrigating needle was ejected. (A) The 27 gauge needle penetrated through the corneal stroma horizontally from the 9 o'clock clear cornea incision site. (B) After removing the needle, the linear wound remained across the corneal stroma (arrowheads).

• 

  Figure 2 On the 1st postoperative day, the cornea was edematous and Descemet's membrane folds were detected. (A) The stromal linear wound was remarkably healed compared to that of the operation day, and (B) the opacity of endothelium was at the around center of the cornea (arrowheads). Anterior segment optical coherence tomography showed (C) linear wound of stroma and (D) minimal enlargement of stroma with detachment of Descemet's membrane (arrowheads).

• 

  Figure 3 On the 6th postoperative day, corneal edema and Descemet's membrane folds were greatly improved. (A) Stromal lesion was almost disappeared and (B) endothelial opacity was also nearly faded (arrowheads). About 3 weeks after surgery, visual acuity of affected eye was 0.9 and astigmatism wasn't induced by the penetrating injury. (C) No corneal opacity remained and (D) rebuilding process of corneal stroma, Descemet's membrane and endothelium was fairly successful without any sequela.

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