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To the Editor.
—During the anterior capsulotomy portion of extracapsular cataract extraction, a small piece of anterior capsule may become adherent to corneal endothelium. The capsule fragment acts as a nonpermeable membrane and causes a localized area of bullous keratopathy. On the first postoperative day, the edematous area is sufficiently hazy to prevent identification of the outline of the fragment. During the next several days, the edema subsides and the fragment can be seen adherent to endothelium. The edema remains, and, over the course of several months, an area of bullous keratopathy develops. The patient experiences a foreign body sensation when epithelial bullae are present. Hypertonic sodium chloride may decrease the symptoms; a bandage contact lens may be necessary. If the capsule fragment's adherence and subsequent edema occur over the visual axis, the vision will be diminished, perhaps sufficiently to warrant a penetrating keratoplasty.When this phenomenon was first identified,
Moses L. Localized Bullous Keratopathy Secondary to Adherent Lens Capsule. Arch Ophthalmol. 1986;104(5):639–642. doi:10.1001/archopht.1986.01050170029008
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