Consultant Ophthalmologist,
Cataract & Refractive Surgeon

BMedSci BM BS MRCS MRCSEd MRCOpth FRCOphth MMedLaw PgD Cataract & Refractive Surgery

Pseudophakic Bullous Keratopathy

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What's going on?

The cornea (the clear window at the front of the eye) stays clear by the action of cells on its inner surface which suck fluid out and maintain a relative state of dehydration. Throughout life there is gradual loss of these cells (ageing I'm afraid). When the cell density drops below a certain critical level, the cornea fills with water derived from the fluid inside the eye and the cornea goes cloudy. This may happen because of ageing or it may be caused by us messing around with the eye in the form of surgery.

Any surgery in the eye (typically cataract surgery) will result in the loss of some of these vital cells. Usually it doesn't matter as you have plenty of reserve however in some patients they do not have enough cells or they lose an unexpectedly large number of cells and the cornea clouds over.

What will my ophthalmologist see?

The cornea will have an appearance similar to frosted glass (hence the blurred vision). This may be mild resulting in minimal blurring or it can be quite marked.

What do I need to know?

The problem is unlikely to resolve without surgery, but corneal grafting tends to have a good visual prognosis. You may decide that you have had enough and that you can manage with the slightly blurred vision you are left with.

If it is severe (which thankfully it rarely is) fluid filled cysts can form which can burst on the surface of the eye. If this happens it can cause some discomfort. In this situation lubricants or a bandage contact lens may be used for comfort.

Going for a corneal graft is a big decision to make – you will need to discuss it in depth with your ophthalmologist.