Acute macular edema and serous detachment on the first day after phacoemulsification surgery: A case report

Abstract

Purpose To report a case of an acute macular edema with serous retinal detachment on the first day after uncomplicated phacoemulsification surgery with the use of a standard dose of intracameral cefuroxime at the end of the surgery. Observations A 46-year-old man underwent a technically uneventful right eye phacoemulsification surgery using a standard dose (1mg/0.1mL) of cefuroxime solution injected into the anterior chamber at the end of the surgery. Serous macular edema and detachment were in our case observed on the first post-operative day. Without surgical intervention fast clinical recovery was observed and best corrected visual acuity improved to the final visual outcome of 1.0, which was satisfactory 10 days after surgery. Conclusions and Importance Acute serous macular detachment and edema should be considered in cases of poor visual acuity in the early postoperative period. The role of a standard dose of cefuroxime toxicity should be more widely explored and discussed.

Retinal toxicity secondary to subconjunctival cefuroxime following pars plana vitrectomy: A case report and literature review

“…We reviewed 102 other published cases of intraocular cefuroxime toxicity or overdose; all but one involved intracameral cefuroxime administration following phacoemulsification cataract surgery ( Table 1 ). 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 The majority of overdose cases were related to dilution or dosing errors during the preparation of intracameral cefuroxime. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 There were 33 cases of toxicity in patients apparently receiving a standard recommended intracameral dose of 0.1 ml of 10 mg/ml solution, although the administered volume was not specified in several reports.…”

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 There were 33 cases of toxicity in patients apparently receiving a standard recommended intracameral dose of 0.1 ml of 10 mg/ml solution, although the administered volume was not specified in several reports. 11 , 12 , 13 , 14 , 16 , 17 …”

High dose cefuroxime causing retinal toxicity in a patient undergoing trabeculectomy

“… Study Dose (mg) No. of eyes Ocular side effects Treatment Recovery Current case report ICC 12.5 1 AC cells, flare, dull foveal reflex, vitritis with moderate vitreous haze OCT: SMD, schisis like changes in ONL, EZ disruption Full-field ERG: decrease a- and b-wave amplitude mfERG: reduced signals in all rings AC washout Topical CCS Topical NSAID SC CCS Orbital floor steroid Normal OCT within 9 days mfERG: residual reduced signal at 7 months Díez-Álvarez et al 21 (2021) ICC 12.5 8 Corneal oedema, marked anterior segment inflammation ECC: reduced OCT: early macular oedema Periocular steroid Permanent disruption of EZ in 1 case Optic neuropathy with RAPD in 1 case ECC reduced <1000 cells/mm 2 in 3 cases Chlasta-Twardzik et al 20 (2020) ICC 1 1 Diffuse macular oedema OCT: SMD and macular oedema at the ONL FFA: early phase - non-fluorescent zone next to the optic disc, surrounded by an irregularly fluorescent band; late phase - diffusing fluorescein from the periphery of the non-fluorescent zone reaching the optic disc Topical CCS Topical NSAID Oral NSAID Oral acetazolamide Oral Pentoxifylline OCT normal within 10 days with no recurrence in 24 months Bryan et al 8 (2019) ICC 1 1 Absent foveal reflection with diffuse m...…”

“… 25 However, ocular toxicity secondary to cefuroxime has been reported with standard 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 and higher doses (2–100mg) of ICC. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 A summary of published reports including the clinical features and management is presented in Table 1 . In cataract surgery, toxicity secondary to subconjunctival cefuroxime has also been reported and is thought to be due to the passage of the drug into the eye through corneal wounds.…”

“…In cataract surgery, intracameral cefuroxime (ICC) became widely accepted, following a multicentre study by the European Society of Cataract and Refractive Surgeons (ESCRS) which demonstrated that ICC administration reduced the incidence of post-op endophthalmitis by five-fold. 1 However, there have been reports of ocular toxicity with standard (1mg/0.1mL) 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 and high doses (2–100mg) of ICC, 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 including retinal toxicity, corneal toxicity and uveitis, with a risk of permanent visual loss from retinal structural damage. 7 , 14 , 21…”