Severe Corneal Complications Associated With Corneal Lubricant Used During Surgery

Abstract

Purpose:

To present a series of cases of corneal chemical burns associated with the use of likely improperly buffered corneal lubricant gel, Goniovisc, during uncomplicated, posterior segment surgery.

Methods:

Cases of postoperative corneal complications following surgeries in which Goniovisc was used were collected from 6 retina practices across the United States between January and August 2016. The preoperative diagnosis, type of procedure, postoperative day 1 corneal findings, treatment method, and time to resolution of the corneal irregularity were recorded. pH testing of Goniovisc lots from this time period was performed using Hydrion litmus paper.

Results:

A total of 157 eyes of 156 patients were found to have corneal complications following relatively simple posterior segment surgeries in which Goniovisc was used. Findings included one or more of the following: corneal epithelial defect (84% of cases), Descemet folds (34%), stromal edema (14%), and superficial punctate keratitis (3%). Time to resolution ranged from 2 to 90 days (mean, 12 days; median, 7 days). Treatment methods included artificial tears (37%), bandage contact lens (28%), antibiotic drops (17%), antibiotic ointment (16%), and patching (9%). Two cases were treated with amniotic membrane grafts. One case required a penetrating keratoplasty due to an old laser-assisted in situ keratomileusis (LASIK) flap with a nonhealing epithelial defect that scarred significantly. Litmus testing of Goniovisc lots from this time period revealed a pH of 4 to 5.

Conclusion:

Chemical burns secondary to improperly buffered corneal lubricant solution should be considered in the differential when corneal injury is encountered following posterior segment surgery.