Indomethacin-Induced Corneal Melting After Cataract Phacoemulsification

Cataract remains the leading cause of reversible blindness worldwide. Inflammatory postoperative complications remain a significant challenge associated with cataract phacoemulsification. These include corneal melting, also known as aseptic keratomalacia, a sight-threatening inflammatory condition that precedes corneal perforation. Case description: a 70-year-old patient underwent cataract phacoemulsification and subsequently developed indomethacin induced corneal erosion. Despite 2 months of conservative treatment, the erosion progressed to a corneal ulcer. To prevent corneal perforation, a prophylactic conjunctival flap was performed. Dry eye disease and Sjogren's syndrome were diagnosed postoperatively. Follow-up was 5 years. Conclusions: the presented case demonstrates for the first time the role of indomethacin as a trigger of corneal melting after cataract phacoemulsification. Corneal melting, potentially leading to corneal perforation, may occur after successful surgery not only in patients with diagnosed dry eye disease and systemic collagenosis but also in asymptomatic patients. Torpid progression, resistance to conventional therapy and a high risk of corneal perforation require a specialist to select appropriate therapeutic and surgical treatment methods as soon as possible. Treatment begins with withdrawal of NSAIDs, local and systemic steroid therapy, intensive corneal lubrication and objective monitoring using anterior segment optical coherence tomography.