Supplementary Material for: Iatrogenic Corneal Puncture at the Beginning of Cataract Surgery Which Was Managed Uneventfully

Introduction: Cataract surgery is one of the most commonly performed surgical procedures worldwide. Intraoperative and postoperative complications of cataract surgery include posterior capsule rupture, retinal detachment, suprachoroidal hemorrhage, cystoid macular edema, endophthalmitis, and intraocular lens (IOL) dislocation. As corneal perforation is rarely related to cataract surgery, we report a case of intraoperative iatrogenic corneal puncture that led to a full-thickness laceration that was managed without severe complications. Case Presentation: An 81-year old woman underwent immediate sequential bilateral cataract surgery (ISBCS). Cataract grading of both eyes was nuclear color grade II and cortical cataract grade III, according to the lens opacity classification system III (LOCS III). While performing cataract surgery on her right eye, a corneal puncture with a keratome incidentally occurred just before making the main temporal incision, resulting in a 3 mm full-thickness laceration at the peripheral cornea. One bite of 10-0 nylon suture was placed, and the remaining procedure was performed through a superior main incision. Three bites of 10-0 nylon suture were placed at the laceration site at the end of the procedure. The uncorrected visual acuity was 20/40 in both eyes the following day. Corneal astigmatism increased in the right eye and the refractive error was more myopic than targeted. No leakage was observed. Conclusion: Slight corneal contact with a keratome can lead to full-thickness laceration when the anterior chamber is filled with an ophthalmic viscosurgical device (OVD) during cataract surgery. Caution should be exercised while manipulating sharp surgical instruments to avoid such complications.