Toxic endothelial cell destruction syndrome after intraocular lens repositioning with intracameral epinephrine

Abstract

A 66-year-old Chinese man developed corneal endothelial decompensation after intraocular lens (IOL) repositioning using intracameral epinephrine was performed. The presentation was compatible with toxic endothelial cell destruction syndrome, which is caused by prolonged, direct exposure of the corneal endothelium to relatively high concentrations of intracameral epinephrine. Despite its effective and immediate mydriatic effect, intracameral epinephrine is not recommended for intraoperative mydriasis in procedures such as IOL repositioning or secondary IOL implantation in which minimal irrigating solution is used.

Effect of intracameral epinephrine use on macular thickness after uneventful phacoemulsification

“…Pong et al 16 report a case of toxic endothelial cell destruction after intracameral epinephrine use during an IOL repositioning procedure. The intracameral epinephrine contained a preservative, had a relatively high concentration, and was used for a prolonged period with direct exposure.…”

Pediatric intraoperative floppy iris syndrome associated with persistent pupillary membrane

“…Use of intracameral epinephrine for intraocular procedures requiring minimal irrigation may result in longer exposure of corneal endothelium to concentrated epinephrine, resulting in endothelial toxicity. 8 In addition, our review of the literature on intracameral injections for IFIS prophylaxis yielded no description of effects on the crystalline lens most likely because IFIS most commonly occurs in patients undergoing crystalline lens extraction surgery.…”

Síndrome tóxica do segmento anterior

“…In 1992, Monson et al (4) accurately described the toxic anterior segment syndrome (TASS), and similar cases in which the damage was restricted to endothelial cells have been described as the toxic endothelial cell destruction syndrome (TECDS) (5)(6)(7)(8) . The toxic anterior segment syndrome most commonly occurs within 24 hours of anterior segment surgery; however, some cases have a late onset.…”