Grand Rounds

A patient with a past ocular history of a small-aperture corneal inlay in the left eye, placed in Iran for presbyopia, presented with gradually decreasing vision in both eyes and was motivated to be spectacle-free after cataract surgery. Exam was notable for visual acuity of 20/70 in both eyes. Intraocular pressure was normal OU. Slit lamp exam was most notable for visually significant cataracts in both eyes and a well-centered corneal inlay in the left eye with clear surrounding stroma. Dilated fundus exam was unremarkable in both eyes. The inlay was left in place, and the patient underwent uncomplicated phacoemulsification with a monofocal intraocular lens in the left eye targeted to −0.5 D, with a multifocal intraocular lens planned for the right eye. At post-operative week 1, the patient developed a visually significant corneal opacity overlying the inlay, with visual acuity of 20/150 and normal intraocular pressure in the left eye. The cornea service was consulted, and diffuse lamellar keratitis, pressure-induced stromal keratopathy, toxic anterior segment syndrome, and infectious keratitis were determined to be unlikely. The patient was treated with oral steroids. At the most recent visit, visual acuity was 20/50 in the left eye. Cataract surgery in the right eye was successfully performed with a multifocal intraocular lens with satisfactory visual outcomes.

Presentation Date: 11/05/2026
Issue Date: 11/06/2026