Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery.
OBJECTIVE
To report cases of intraocular inflammation after intracameral injection of a very high dose of cefuroxime at the end of uneventful cataract surgery.


METHODS
Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France.


METHODS
Case series.


METHODS
Patients were followed on an outpatient basis and were examined postoperatively at 1 and 5 days and 6 weeks. Central macular thickness, angiography, central corneal thickness (CCT), endothelial cell density (ECD), and electroretinography (ERG) were analyzed to evaluate ocular toxicity.


RESULTS
One day postoperatively, the mean corrected distance visual acuity (CDVA) was 0.95 logMAR ± 0.40 (SD). All the cases had moderate anterior inflammation. Retinal optical coherence tomography scans systematically showed extensive macular edema (mean 843.2 ± 212.7 μm) associated with a large serous retinal detachment. Fluorescein angiograms showed diffuse leakage without abnormal retinal perfusion. At 5 days, the mean CDVA improved significantly to 0.52 ± 0.29 logMAR (P < .005), as did the macular edema and serous retinal detachment (mean 339.4 ± 138.3 μm) (P = .005). At 6 weeks, the mean CDVA reached 0.09 ± 0.06 logMAR. Modifications in CCT and ECD were similar to those observed after uneventful phacoemulsification. The macular thickness (mean 288.4 ± 22.6 μm) and profile returned to normal in all patients, although ERG recordings showed reduced rod photoreceptor cell function (P < .05).


CONCLUSIONS
Intracameral injection of high doses of cefuroxime induced anterior and posterior inflammation. Without surgical intervention, the final visual outcome was satisfactory in all cases. Long-term retinal function, however, must be assessed through repeated ERG recordings.
Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France. marie-noelle.delyfer@chu-bordeaux.fr
Marie-Noëlle
MN
Delyfer
Marie-Bénédicte
MB
Rougier
Sandy
S
Leoni
Qiuhua
Q
Zhang
Francis
F
Dalbon
Joseph
J
Colin
Jean-François
JF
Korobelnik
D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002387:Cataract Extraction; D002444:Cefuroxime / Q000008:administration & dosage* / Q000009:adverse effects*; D016923:Cell Death; D015715:Corneal Edema / Q000139:chemically induced; D004596:Electroretinography; D004728:Endothelium, Corneal / Q000187:drug effects / Q000473:pathology; D005123:Eye; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D007249:Inflammation / Q000139:chemically induced; D056965:Injections, Intraocular; D007430:Intraoperative Care / Q000009:adverse effects*; D008269:Macular Edema / Q000139:chemically induced; D008297:Male; D011184:Postoperative Period; D012164:Retinal Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D014792:Visual Acuity
D000900:Anti-Bacterial Agents; D002444:Cefuroxime