Ocular Microbiology and Immunology Group
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2026 OMIG Abstract

POSTER PRESENTATION


Immune-Mediated Corneal Melt and Persistent Epithelial Defects After Cataract Surgery in Patients with Autoimmune Disease

Jaime D. Martinez¹, Felipe Echeverri Tribin², Andrea Naranjo¹, Anat Galor¹,
and Guillermo Amescua¹

¹Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; ²University of Miami Miller School of Medicine, Miami, Florida

Purpose: To describe severe, immune-mediated ocular surface complications following cataract surgery in patients with autoimmune disease and to emphasize that such complications may be a sign of previously undiagnosed systemic autoimmunity.

Methods: Retrospective case series of two women who developed refractory corneal complications after phacoemulsification with intraocular lens implantation. Clinical course, medical and surgical interventions, serologic work-up, and outcomes were reviewed.

Results: Patient 1, a 59-year-old woman with known overlap CREST syndrome, Sjögren syndrome, and primary biliary cholangitis on chronic low-dose corticosteroid, developed a persistent Seidel-positive wound leak progressing to corneal melt with a non-healing epithelial defect after right-eye surgery. Autoimmune serologies corroborated her overlap disease, with high-titer ANA (1:2560), positive SSA/Ro and SSB/La, positive anti-mitochondrial/M2 antibodies, and positive anticentromere antibody. Management required a bandage contact lens, incision suturing, cyanoacrylate glue, and amniotic membrane, culminating in a conjunctival flap; planned second-eye surgery was deferred. Patient 2, a 76-year-old woman with no known autoimmune disease, underwent left-eye surgery complicated by intraoperative floppy iris syndrome and a subsequent persistent epithelial defect with corneal edema and suspected herpetic reactivation, requiring repeated amniotic membrane and tarsorrhaphy. The non-healing cornea prompted a systemic work-up revealing a positive ANA and high-titer antiphospholipid antibodies, establishing a new diagnosis of antiphospholipid syndrome. Both corneas ultimately stabilized, with chronic severe dry eye symptoms persisting on long-term follow-up.

Conclusions: Autoimmune disease can predispose to severe, treatment-refractory corneal breakdown after cataract surgery, and a persistent postoperative epithelial defect or keratolysis may be the first manifestation of occult systemic autoimmune disease. Recognition warrants prompt ocular surface rescue, judicious corticosteroid use, and serologic evaluation, with cautious consideration of elective second-eye surgery.