title: [Early macular edema after phacoemulsification and suspected overdose of cefuroxime: report of six cases].
abstract: Antibiotic prophylaxis by intracameral cefuroxime injection, 1mg/0.1 mL after cataract surgery is increasing in popularity. Several cases of early postoperative macular edema have recently been reported after cefuroxime injection, most of them due to accidental cefuroxime overdose. We report six additional cases of macular involvement after cataract surgery, with intracameral cefuroxime injection imputed to cause retinal toxicity. Formal proof of cefuroxime overdose has never been possible, due to rapid wash-out in a few hours and the diagnosis of the macular edema the day after surgery or within a few days. Thus, this strong suspicion is based on clinical, pharmacokinetic, tomographic and retinographic criteria. In our series of six cases, the first four patients involved the same surgeon in the same hospital, and two of them on the same day. For the sixth case, the diagnosis was made retrospectively and based on history and medium-term tomographic characteristics. All the patients underwent optical coherence tomography (OCT) relatively early. As early as day one after surgery, there is macular edema predominantly in the outer retinal layers associated with serous retinal detachment, similar to the cases described in the literature. In the late stage, three patients had functional impairment related to photoreceptor damage on OCT. Three cases are described with additional retinal imaging (angiography, autofluorescence) to better characterize this macular toxicity associated with cefuroxime.
authors.affiliation: Service II, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex 12, France. Electronic address: brivael.ledu@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Le Dû
authors.affiliation: Service d'ophtalmologie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France.
authors.forename: V
authors.initials: V
authors.lastname: Pierre-Kahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000506:poisoning*; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000506:poisoning*; D062787:Drug Overdose / Q000150:complications*; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime
keywords: Antibioprophylaxie; Antibiotic prophylaxis; Cataract surgery; Cefuroxime; Chirurgie de cataracte; Céfuroxime; Macular edema; Overdose; Phacoemulsification; Phacoémulsification; Retinal toxicity; Surdosage; Toxicité rétinienne; Œdème maculaire
vernacular_title: Œdème maculaire après phacoémulsification et suspicion de surdosage en céfuroxime : à propos de 6 cas.