Retinal complications of intracameral cefuroxime in cataract surgery
Author: Eleni Spathi (Greece)
Co-authors: Maria Sourla, Paraskevi Karra, Sofia Anagnostopoulou
To report two cases of retinal toxicity after intracameral use of cefuroxime at the end of cataract surgery.
Ophthalmology Department, General Hospital of Larisa, Larisa, Greece
Case 1: a 78-year-old female patient underwent uneventful left phacoemulsification surgery using a standard dose of intracameral cefuroxime (1mg/0.1ml) at the end of the procedure. On the first post-operative day, fundoscopy revealed retinal pallor and oedema in the perimacular area and OCT findings consisted of serous retinal detachment and outer nuclear layer thickening in the perimacular area. Our patient received typical post-operative treatment and a watchful wait approach was adopted. Case 2: a 77-year-old female patient underwent right complicated phacoemulsification cataract surgery with posterior capsular rupture. Anterior vitrectomy was performed, IOL was placed in the sulcus and an inadvertent high dose of intracameral cefuroxime (over 4ml, concentration: 1mg/0.1ml) was injected in the anterior chamber. As a consequence, hemorrhagic retinal infarction ensued in the macular area and inferior retinal region as observed in fundoscopy on the first post-operative day.
In our first case macular oedema and serous retinal detachment resolved spontaneously on the third post-operative day with optimal visual outcome. In our second case prognosis was poor. Visual aquity was Counting Fingers at 1m and fundus developed atrophy in the aforementioned areas.
Both safety and efficacy of intracameral use of cefuroxime in cataract surgery are well documented. Nevertheless, both standard and high-dose of cefuroxime are related to mild, self-limited and severe complications respectively. Therefore, extreme caution must be taken in preparation and use of cefuroxime during cataract surgery.
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