LAUSR

TO THE EDITOR: Once the balance between the physiological processes of the cornea is disrupted by mechanical, infective, inflammatory or toxic aetiologies, corneal oedema ensues [1, 2]. Delayed onset corneal oedema in a pseudophakic patient can have several infective and inflammatory aetiologies, however, retained intraocular foreign body should be considered. Figure 1a illustrates inferonasal epithelial and stromal oedema encroaching onto the visual axis in the left eye of an 84 year old pseudophakic patient, which did not present until six months after uncomplicated cataract surgery. The working diagnosis prior to referral to us was viral keratitis, but treatment for this did not cause resolution of the corneal oedema. At referral, the patient’s vision was counting fingers, and there were no corneal findings suggestive of inflammation. Gonioscopy revealed a foreign body in the inferior iridocorneal angle (Fig. 1b). It was removed under local anaesthetic and sent for histopathological assessment and found to be non-organic (Fig. 1c). The corneal oedema resolved post operatively. We believe that the haptic of the Akreos MI60L intraocular lens (IOL) (Baush and Lomb, New Jersey, USA) became fractured at the optic haptic junction, and dislodged intraoperatively during the IOL insertion process with a Visco-jet BIO 2.2 injector (Medicel, AG, Switzerland). The process of ‘blooming’ (legal manufacturer personal communication), where the plunger overrides the lens, contributes to fracture at the optic haptic junction, with the haptic becoming trapped between the cartridge and the plunger (Fig. 1d, not from