Brown-Mclean syndrome associated with corneal endotheliitis in a pseudophakic eye

Brown-McLean syndrome

BACKGROUND

Brown-McLean syndrome is a rare corneal presentation usually resulting from intracapsular cataract extraction or multiple anterior segment surgeries and the passage of time.

CASE REPORTS

Two patients presented to our clinic with Brown-McLean syndrome. Both had undergone intracapsular cataract extraction with peripheral iridectomies many years before their current examinations.

CONCLUSIONS

Brown-McLean syndrome can be overlooked or misdiagnosed. Although intracapsular cataract extraction is rare in this country today, eye doctors should be made aware of its presence and potential side effects.

Anterior stromal puncture in Brown-McLean syndrome

We describe 2 cases of Brown-McLean syndrome with corneal edema successfully treated by anterior stromal puncture (ASP). Ophthalmologic examinations showed peripheral edema and aphakia in both patients. The patients had ASP to control the severe foreign-body sensation. The procedure was effective over a long-term follow-up, suggesting that peripheral ASP may be an effective therapeutic option for patients with symptomatic Brown-McLean syndrome.

Corneal edema after cataract surgery: incidence and etiology

Corneal edema from inadequate endothelial pump function is one of the most common complications of cataract surgery. Various causes for this endothelial dysfunction can be divided into four categories including (a). mechanical injury, (b). inflammation/infection, (c). chemical injury, and (d). concurrent eye disease. This review serves as a basis for the diagnosis and treatment of this complication.

Corneal endothelial cell loss caused by detached opacified anterior lens capsule in the anterior chamber

From 1984 to 1986, we performed cataract surgery through a 1.5 mm anterior capsule hole in 77 eyes. The hole was enlarged to 6.0 mm by a slit incision, and an intraocular lens was implanted into an almost completely intact capsular bag. Twelve (16%) eyes developed severe postoperative anterior capsule opacification. The opacified central anterior capsule, approximately 5 mm in diameter, was detached by can-opener anterior capsulotomy using a neodymium:YAG laser and fell into the inferior anterior chamber. Inferior corneal endothelial cell loss occurred in nine of the 12 eyes within 20 months after detachment; in six of the nine, inferior corneal endothelial cell density decreased 50% more than central cornea cell density. This method will be unsuitable for treating the extensive anterior capsule opacification that will occur when endocapsular cataract surgery that retains most of the lens capsule is widely performed in the future.