Linear Endotheliitis Following Posterior Chamber Phakic Intraocular Lens Implantation

Abstract

PURPOSE: To describe a case of linear corneal endotheliitis in a healthy patient with no previous relevant ophthalmic history other than high myopia, who unilaterally developed this disease during the early postoperative period after Implantable Collamer Lens (ICL; STAAR Surgical) phakic intraocular lens (IOL) implantation. METHODS: Case report. RESULTS: An ICL was uneventfully implanted in the right eye of a 42-year-old woman. After normal examination results at 24 hours postoperatively, sudden loss of vision occurred 48 hours postoperatively due to a moderate focal stromal and epithelial edema at half of the cornea, with a sharp transition between the edematous and the healthy cornea delimited by a fine line of keratic precipitates, associated ocular hypertension, and fine anterior chamber cellular activity. Results of a polymerase chain reaction test of the aqueous humor for herpes virus were negative, but the patient reported a previous history of herpes labialis. Diagnosis of linear endotheliitis was established, and empirical treatment with oral valaciclovir, topical hypotensive drugs, and intense topical steroid was started. Complete resolution of the corneal edema and cellular activity occurred after 2 weeks of treatment. Although visual potential was fully restored, endothelial cell density decreased to less than 1,000 cells/mm 2 , and recurrent episodes of mild hypertensive iritis with difficult intraocular pressure control resulted in explantation of the ICL 2 months after surgery. CONCLUSIONS: This is the first case reported of linear endotheliitis after phakic IOL implantation. The observation of severe focal corneal edema after any uneventful intraocular surgery should lead to the suspicion of this rare disease, where an early diagnosis and intensive empirical treatment are essential for a successful outcome. [ Journal of Refractive Surgery Case Reports. 2021;1(2):e19–e22.]