Extensive bilateral corneal edema 6 weeks after cataract sur
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Surgeons may be unaware of the ability of plant toxins to cause corneal damage. Therefore, corneal damage following intraocular surgery due to plant toxins may be misdiagnosed as a postoperative infection.

Case presentation
A 74-year-old man presented with hyperemia and reduced visual acuity in both eyes 6 weeks after uneventful cataract surgery. Extensive hyperemia and corneal stromal edema with Descemet’s folds were observed in both eyes.

After obtaining a detailed patient history, we diagnosed plant toxin-induced corneal edema due to Asclepias physocarpa, which can induce corneal edema by inhibiting the Na+/K+ ATPase activity of the corneal endothelium.

Antimicrobial and steroid eye drops and an oral steroid were prescribed accordingly. Symptoms began to improve on day 3 and had almost completely resolved by day 6. At 1 month, the patient had fully recovered without any sequelae.

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