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Long term recovery of the human corneal endothelium after toxic injury by benzalkonium chloride
  1. Edward H Hughes (edward.hughes1{at},
  2. Marike Pretorius (marike.pretorius{at},
  3. Haralabos Eleftheriadis (h.eleftheriadis{at},
  4. Christopher SC Liu (cscliu{at}
  1. Sussex Eye Hospital, United Kingdom
  2. Sussex Eye Hospital, United Kingdom
  3. Sussex Eye Hospital, United Kingdom
  4. Sussex Eye Hopsital, United Kingdom


    Introduction: Inadvertent intra-ocular administration of benzalkonium chloride-preserved hydroxypropyl methylcellulose during cataract surgery at another hospital in 1999 resulted in toxic corneal endothelial injury and profound post-operative corneal oedema due to endothelial decompensation. We assessed the long-term effect of this adverse event.

    Methods: All 19 patients were invited to return for examination including corneal endothelial specular microscopy and pachymetry 7 years after the incident. Results were compared with data from 1 year after the incident.

    Results: Five patients attended for examination, one had received a penetrating keratoplasty and was, therefore, excluded. Ten patients were deceased and four had moved out of region and were unable to attend. All four study patients were pain-free and achieved 6/12 or better. Mean central corneal thickness reduced by 13% from 652.6μm at one year to 563.4μm. Mean central corneal endothelial cell density (n=3) increased 28% from 663.7 cells/mm2 at one year to 835.7 cells/mm2 (p<0.05).

    Conclusions: Following toxic injury corneal endothelial function may have a remarkable capacity for recovery even after the first post-operative year. The rise in central endothelial cell density may represent cell migration from less affected areas or cellular proliferation. Should this unfortunate event recur, clinicians may expect continued recovery beyond one year.

    • benzalkonium chloride
    • cataract surgery
    • corneal endothelium
    • pachymetry
    • specular microscopy

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