Big bubble post phacoemulsification: An unexpected and rare complication

This case report describes a rare presentation of a DALK-like intra-corneal big bubble after phacoemulsification cataract surgery in a 42-years-old female, demonstrating the need for careful hydration of incisions after phacoemulsification surgery. A 42-year-old female presented with visually significant bilateral cataracts (visual acuity right eye (OD): hand movement, left eye (OS): 20/40). She underwent uncomplicated cataract surgery in the right eye until a large bubble was noted centrally between the corneal layers after hydration of side ports and main incision. At postoperative visit 1, the vision was 20/250 OD and AS-OCT confirmed air between posterior corneal stroma and Descemet’s layer. The patient was kept on routine postoperative medications and observation. On subsequent visits by first week, the air was found to be absorbed. It was determined that air was inadvertently injected between corneal stroma and Descemet’s layer, causing a decrease in early postoperative vision, which improved gradually with a final uncorrected visual acuity of 20/25 by 1 month. Improper and forceful hydration of incisions may lead to complications such as Descemet’s membrane detachment, iris prolapse, and corneal edema. This case emphasizes the need for checking of cannulas before hydration to ensure no presence of air in the hydrating syringes along with careful slow hydration of incisions.