The cataract surgery of Empress Eugenie of France a century ago by the eminent Spanish ophthalmologist Ignacio Barraquer.

Topic: Empress Eugénie (1826-1920), the widow of Emperor Napoléon III of France, developed mature cataracts late in life. In 1920, at age 94, she underwent surgery to one eye by Ignacio Barraquer (1884-1965), a member of the famous dynasty of ophthalmologists originally from Barcelona, Spain. Clinical relevance: Barraquer used his new instrument which employed a vacuum cup to hold the lens for intracapsular extraction. Methods: Research of historical documents. Results: The surgery was a success; the Empress was pleased that she could read again although she did not have long to live. She was his first famous cataract patient and his fame spread internationally. Barraquer spoke at the International Congress of Ophthalmology held in Washington, DC, in 1922 and demonstrated his technique on patients in Washington, DC, New York, Boston, Philadelphia and Richmond, VA. Conclusion: Barraquer's surgery on Éugenie, who was the most powerful woman in Europe during her husband's reign, influenced the course of development of cataract surgical technique.

Unusually delayed presentation of persistent Descemet's membrane tear and detachment after cataract surgery.

A 51-year-old male who had undergone phacoemulsification in his left eye 11 months prior presented with complaint of sudden onset of blurred vision in the same eye. Review of his clinical course, slit-lamp exam, pachymetry, and specular endothelial microscopy led to the diagnosis of acute hydrops caused by Descemet's membrane dehiscence at the site of the incision. He was initially managed with medical treatment and observation. In the subsequent months of follow-up, the corneal edema and the patient's visual acuity did not improve. Intracameral gas injection was performed 7 months after presentation, but because of persistent corneal edema and nonattached Descemet's membrane, penetrating keratoplasty was performed. Histopathologic examination confirmed the diagnosis. The patient has had a clear corneal graft since then. Although Descemet's membrane detachment is a rather common complication after intraocular surgery, its unusually delayed presentation can also occur, and should not be confused with pseudophakic bullous keratopathy. Many mechanisms have been studied for the development of early tears and detachments after cataract surgery, but little is known about late presentations. The authors explore possible causes, and highlight the importance of instructing patients to avoid eye rubbing and any other type of trauma to the cornea after intraocular surgery.