Corneal toxicity secondary to inadvertent use of benzalkonium chloride preserved viscoelastic material in cataract surgery

Abstract

Aims: To study the long term toxic effects of intraocular benzalkonium chloride (BAC). Methods: 19 patients exposed to intraocular BAC preserved viscoelastic during cataract surgery in February 1999 developed severe striate keratopathy immediately postoperatively. 16 patients, including two who underwent penetrating keratoplasty, were studied in the period April to June 2000. Ocular symptoms, visual acuity, biomicroscopy, intraocular pressure, dilated funduscopy, specular endothelial microscopy, and corneal pachymetry findings were recorded. The corneal and iris specimens of the two patients who underwent keratoplasty were studied by light, transmission, and scanning electron microscopy. Results: Six males and 10 females, aged 64-98 years, were studied 14-16 months postoperatively. All patients were symptomatic. 12 patients had best corrected visual acuity of 6/12 or better and four patients of between 6/18 and 6/60. Five patients had corneal epithelial oedema and 11 had Descemet's membrane folds. The central corneal thickness, 620 (SD 71) µm, in affected eyes was significantly higher (p<0.005, two tailed paired t test) than that of the contralateral eyes, 563 (SD 48) µm. The endothelial cell density was significantly lower (p<0. . There was no significant difference in the coefficient of variation of cell size between the two eyes (p=0.3, two tailed paired t test). Two corneal specimens displayed morphological features of bullous keratopathy and other nonspecific abnormalities. Extracellular melanosomes were present in a portion of the iris of one case. Conclusion: BAC is toxic to the corneal endothelium when used intraocularly, leading to severe striate keratopathy. This cleared in most cases but left varying degrees of residual stromal thickening in all eyes. If penetrating keratoplasty is required the results are excellent.

Detrimental effect of preservatives in eyedrops: implications for the treatment of glaucoma

“…Evidence from animal studies and human tissue cell culture experiments, which suggests that preservatives can cause detrimental effects on the superficial ocular tissues, is supported by evidence from clinical studies (Wilson et al 1975;Lemp & Zimmerman 1988;Sherwood et al 1989;Herreras et al 1992;Baudouin et al 1994;Broadway et al 1994a;de Jong et al 1994;Kuppens et al 1995;Yalvac¸et al 1995;Aritu¨rk et al 1996;Baudouin 1996;Baudouin & de Lunardo 1998;Nuzzi et al 1998;Levrat et al 1999;Albietz & Bruce 2001;Eleftheriadis et al 2002;Dogan et al 2004;Pisella et al 2004;Kozobolis et al 2005;Manni et al 2005;Hong et al 2006). The key studies are outlined here and a full list of references is provided in Table 1.…”

Toxic anterior segment syndrome: Update on the most common causes

“…5,[22][23][24] In addition, stabilizing agents such as bisulfites and metabisulfites, which are often used to maintain epinephrine in the reduced state, have been linked to TASS. 25 This is especially important to acknowledge when mixing intracameral preparations such as epi-Shugarcaine.…”

Phytosome-hyaluronic acid systems for ocular delivery of L-carnosine

“…The positive control (BKC) has been shown to be cytotoxic at the duration tested in this study. [38][39][40] While there were slight decreases in cell viability after exposure to the different formulations and L-carnosine solution, these were not statistically significant compared to the negative control (P.0.05). It is worth noting that BKC (which for durations comparable to this study is cytotoxic) is used routinely as a preservative in too many commercially available eye drops at a concentration of 0.01% w/v; the duration of exposure of BKC to the eye when applied in eye drops is considerably shorter.…”