Brown-McLean syndrome after phacoemulsification.

A 73-year-old male, presented to us with pricking and foreign body sensation right eye (RE) since 2 years. He had undergone phacoemulsification and posterior chamber intraocular lens (PCIOL) implantation elsewhere eight years back. Visual acuity in RE was 20/20, N6, and in left eye (LE) was 20/200, N12. RE showed peripheral ring-like corneal edema, with bullae in temporal and nasal quadrants [Fig. 1 red arrow] and superficial vascularization at seven “o” clock position. PCIOL was seen in situ. LE examination was within normal limits except for cataract.

Figure 1

Peripheral ring-like corneal oedema with bullae (red arrow)

Intraocular pressure was 14 mmHg and 16 mmHg in RE and LE, respectively. Gonoiscopic evaluation was normal. Specular microscopy of central cornea of both eyes showed adequate endothelial count with normal morphology [Fig. 2]. Fundus examination was normal in both eyes. Scheimpflug imaging of RE showed average peripheral and central corneal thickness of 1000 and 560 microns, respectively [Fig. 3].

Figure 2

Specular microscopy showing adequate endothelial cell count with normal morphology

Figure 3

Scheimpflug imaging of RE with average peripheral cornael thickness 1000 microns

Based on the examination, he was diagnosed to have RE Brown-Mclean syndrome (BMS). Patient was advised topical lubricants and hyperosmotic agents. At one-month review, he was symptomatically better with resolved bullae [Fig. 4 red arrow] and reduced (average 860 microns) peripheral corneal thickness; however peripheral corneal oedema persisted [Fig. 5].

Figure 4

At one-month review, resolved bullae (red arrow)

Figure 5

Sheimpflug imaging RE with reduction to an average peripheral corneal thickness to 860 microns

BMS is a rare condition of peripheral corneal oedema with underlying endothelial pigmentation, seen in aphakia, pseudophakia, following pars plana lensectomy and vitrectomy.[12] The oedema is often observed after several years following surgery, typically starting inferiorly, with progression may involve the entire circumference.[2]

The syndrome is often asymptomatic, but patients may present with foreign body sensation, or pain due to a ruptured bullae.[2] The exact cause is unknown, we too did not find one. Confocal microscopy, however, showed normal corneal endothelium in terms of morphology and count in patients with BMS.[3] There is no definitive treatment for this condition.[3]

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Conflicts of interest

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