Large corneal epithelial detachment as a complication of wound burping to release aqueous humor for elevated intraocular pressure following cataract surgery.

Wound burping is a technique used to treat intraocular pressure spikes in the immediate postoperative period after cataract surgery. A 55-year-old man with no history of glaucoma presented with painless blurring of vision in his left eye following cataract surgery 20 days earlier. Ophthalmic examination disclosed elevated intraocular pressure, mild conjunctival hyperemia, corneal microcystic epithelial edema, and mild anterior chamber reaction. In an attempt to lower the intraocular pressure quickly, the corneal wound was 'burped' at the slitlamp. Upon burping the wound, a large epithelial bulla formed instantly in the cornea. The patient's blinking caused the corneal epithelial bulla to burst and collapse. Examination the next day disclosed the detached epithelium had sloughed off completely. The epithelial defect healed gradually over 10 days. Wound burping to release aqueous humor after the corneal epithelium has healed over the surgical incision can result in corneal epithelial detachment and should be avoided.

Severe astigmatism secondary to large intraocular lens pantoscopic tilt because of a malpositioned haptic following cataract surgery.

An 80-year-old woman presented with painless blurring of vision and monocular diplopia in her left eye following routine phacoemulsification and monofocal intraocular lens (IOL) implantation 5 weeks earlier. Her uncorrected visual acuity (VA) was 6/60 correctable with pinhole to 6/21. Her best-corrected VA was 6/15 with a subjective refraction of -0.50DS/-5.25DCx37. Her corneal astigmatism was -1.25DCx74. Ophthalmic examination disclosed a severely tilted single-piece posterior chamber IOL in the capsular bag. The inferior portion of the optic was tilted posteriorly because of a twisted and malpositioned haptic. The patient underwent remedial surgery to untwist and reposition the IOL haptic which led to immediate improvement of the IOL position. Her uncorrected VA improved to 6/12-2 correctable with pinhole to 12+1 with an autorefraction of +0.25DS/-2.00DCx74 on the first postoperative day. One month postoperatively, her best-corrected VA was 6/12 with a refraction of +0.50DS/-2.50DCx82. Her final vision was limited by myopic macular degeneration.