Reversible cataract after exposure to distilled water: a case report

Abstract

BackgroundTo report a case of a reversible cataract after intracameral infusion of distilled water during full-thickness astigmatic keratotomy.Case presentationA 20-year-old male whose bilateral anterior chambers were exposed to distilled water during astigmatic keratotomy developed bilateral corneal edema, inflammation of the anterior chambers, and an anterior subcapsular cataract in the right eye. After 1 month of topical administration of 0.1% prednisolone acetate and 5% NaCl, the bilateral inflammation of the cornea and anterior chambers cleared; endothelial cell density decreased by 41.1% in the right eye and 12.7% in the left eye. The cataract in the right eye decreased centripetally. Small incision lenticule extraction surgery was performed at 2 months after the astigmatic keratotomy; the patient’s uncorrected distance visual acuity 3 months later was 20/25 in both eyes.ConclusionsThis case suggests that a cataract that develops as a result of instantaneous intracameral exposure to distilled water is reversible.

Spontaneous resolution of a unilateral cataract in an adult

“…The spontaneous regression of traumatic cataracts is mainly seen in cases of intraocular foreign bodies, penetrating injury, yttrium aluminum garnet laser, and cataracts caused by distilled water. [2][3][4][5][6][7] When lens integrity is compromised due to direct damage to the lenticular capsule, cataracts can occur due to aqueous humor influx into the lens lamella and denaturation of the lens protein. [16] However, lenticular capsule damage is limited and can heal without progressive cataract formation in rare cases, leading to resolution.…”

“…Spontaneous resolution of cataracts has been reported due to local causes, such as intraocular surgery, trauma, and yttrium aluminum garnet laser iridotomy [2–7] . Furthermore, the spontaneous regression of cataracts has also been reported due to systemic causes, such as uncontrolled hyperglycemia [8–15] .…”

“…However, in rare cases, spontaneous cataracts regression has been reported. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] Among the various cataract types, most spontaneous resolution has been reported in posterior subcapsular cataract (PSC) that show dynamic changes unlike other types of cataracts. [16] In PSC, vision loss can occur early, because the opacity is located at the nodal point of the lens.…”

“…Furthermore, most cataracts occur in both eyes, and when hyperglycemia improves, cataracts also improve. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, spontaneous resolution of unilateral cataracts in patients with well-controlled diabetes is very rare. In general, even if there is an underlying disease such as diabetes, if no major abnormalities are observed in the current examination, cataract surgery is often planned immediately without follow-up, which may lead to unnecessary cataract surgery.…”

Cataract Surgery by Intraoperative Surface Irrigation with 0.25% Povidone–Iodine

“…In the operating room, 0.25% povidone-iodine is prepared by adding an appropriate volume of 5% or 10% povidone-iodine into a 100-mL or 250-mL physiological saline bottle (Figure 8). Note that the solution should not be prepared in distilled water, because washing the cornea with a solution diluted in distilled water may cause corneal damage due to low osmotic pressure [68]. A washing needle is attached to the cap of the bottle, which will be convenient for irrigating the eye surface.…”