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

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.