title: Toxic endothelial cell destruction from intraocular benzalkonium chloride.
abstract: OBJECTIVE
  To present a cluster of cases of corneal edema occurring after phacoemulsification.
  
  
  METHODS
  Regional hospital in rural Australia.
  
  
  METHODS
  This retrospective case series comprised 12 patients from a single surgical list comprising 19 cases who developed persistent corneal edema after having phacoemulsification.
  
  
  RESULTS
  After 6 months, the edema improved in 1 patient. Inadvertent intraocular use of balanced salt solution (BSS) preserved with benzalkonium chloride was found to be the cause of this serious complication.
  
  
  CONCLUSIONS
  Benzalkonium chloride in concentrations commonly used extraocularly is highly toxic to the corneal endothelium. Every possible safeguard should be taken to prevent inadvertent intraocular use of such preserved solutions.
authors.affiliation: Orana Eye Centre, Dubbo, New South Wales, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.forename: I
authors.initials: I
authors.lastname: Routley
authors.forename: K D
authors.initials: KD
authors.lastname: Teichmann
mesh_terms: D000085:Acetates; D001548:Benzalkonium Compounds / Q000009:adverse effects*; D015715:Corneal Edema / Q000139:chemically induced*; D004338:Drug Combinations; D004728:Endothelium, Corneal / Q000187:drug effects*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008903:Minerals; D018918:Phacoemulsification; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects*; D012189:Retrospective Studies; D012965:Sodium Chloride; D014792:Visual Acuity
chemical_list: D000085:Acetates; C030660:BSS solution; D001548:Benzalkonium Compounds; D004338:Drug Combinations; D008903:Minerals; D011310:Preservatives, Pharmaceutical; D012965:Sodium Chloride