Postcataract surgery gray-white lines of the corneal endothelium viewed with confocal microscopy and review of literature

Abstract

Introduction: Cataract surgery rarely causes 1-day postoperative corneal endothelial changes visibly seen as patches or linear streaks. Previously described as “snailtracks,” these changes have been studied using slitlamp examination (SLE), scanning electron microscopy, and specular microscopy, but to the best of the authors' knowledge, it has yet to be analyzed using confocal microscopy. Patient and Clinical Findings: 3 patients who underwent cataract surgery through phacoemulsification with intraocular lens implant were found to have snailtracks on the corneal endothelium during postoperative day 1 examination. Diagnosis, Intervention, and Outcomes: The corneal endothelium of the 3 identified patients underwent SLE and in vivo confocal microscopy on postoperative day 1 and postoperative week 1. On day 1, linear opacities were visible on the corneal endothelia and confocal microscopy revealed disruptions of the regular polygonal endothelial pattern with cell aggregation. At 1 week, opacities had resolved and confocal microscopy demonstrated reorganization of the endothelia and appearance of hyperreflective nuclei. Conclusions: Confocal microscopy of postcataract surgery snailtracks supports the hypothesis that such endothelial opacification is secondary to trauma to the endothelium.