Limits...
A case of inadvertent anterior chamber and corneal stromal injection with antibiotics during cataract operation.

Ha BJ, Lee SH, Kim YM, Kwon HS, Chu YK, Seo KY - Korean J Ophthalmol (2006)

Bottom Line: Four weeks postoperatively, corneal edema began to reduce significantly.However, some Descemet's membrane folds still remained, and a decrease in the number of endothelial cells was noted by specular microscope.To prevent such mistakes, precise labeling of all solutions and use of different syringe needles should be considered.

View Article: PubMed Central - PubMed

Affiliation: Siloam Eye Hospital, Seoul, Korea.

ABSTRACT

Purpose: To report a case of inadvertent anterior chamber and cornea stromal injection with high dose antibiotics and steroids during cataract operation.

Methods: During cataract operation on a 78 year-old female patient, high dose gentamicin (20 mg/0.5 ml) and dexamethasone (2 mg/0.5 ml) were inadvertently injected into the anterior chamber and cornea stroma when making cornea edema for sealing of the incision sites. Anterior chamber irrigation with balanced salt solution (BSS) was immediately administered. On postoperative day one, extensive cornea edema was noted, and best-corrected visual acuity was 0.2. Descemet's membrane folds were observed around the corneal incision sites. Topical 5% NaCl and 1% prednisolone were started.

Results: Four weeks postoperatively, corneal edema began to reduce significantly. At four months postoperatively, corneal edema fully resolved, and best-corrected visual acuity was 0.8. However, some Descemet's membrane folds still remained, and a decrease in the number of endothelial cells was noted by specular microscope.

Conclusions: In this case involving anterior chamber and cornea stromal injection with high dose antibiotics and steroids, immediate anterior chamber irrigation with balanced salt solution seemed an appropriate management, and the patient's long-term visual acuity appears good. To prevent such mistakes, precise labeling of all solutions and use of different syringe needles should be considered.

Show MeSH

Related in: MedlinePlus

Diffuse stromal edema (white shaded area) involving the pupil from the 12 to 4 o'clock position.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2908860&req=5

Figure 1: Diffuse stromal edema (white shaded area) involving the pupil from the 12 to 4 o'clock position.

Mentions: On postoperative day one, the patient complained of blurred vision and foreign body sensations. Severe corneal edema and Descemet's membrane folds invading the visual axis were seen extending from the 12 to 4 o'clock position (Fig. 1). Inflammatory cells and flares were 3+ in the anterior chamber. Best-corrected visual acuity was 0.2, and intraocular pressure was 18 mmHg by noncontact tonometer. Postoperatively, Cravit® (levofloxacin 0.5%, Santen, Osaka, Japan), 1% prednisolone, and 5% NaCl were administered every two hours. Oral prednisolone (20 mg) and ofloxacin (300 mg) were used as well. A pressure patch with ofloxacin and dexamethasone ointment was administered during sleep. The corneal edema persisted until postoperative day three, and the best-corrected visual acuity decreased to 0.15. The vision improved to 0.4 after two weeks, but the corneal edema persisted without improvement. The patient continued with the original and medications and dosages. On the third postoperative week, the best-corrected visual acuity stabilized at 0.4, and the corneal edema began to resolve. The visual acuity continued to improve to 0.7, and the corneal edema finally resolved four weeks postoperatively. However, the linear Descemet's membrane folds persisted up to postoperative week 16 (Fig. 2, 3). At the same site of the Descemet's membrane fold, corresponding endothelial damage was also observed, manifesting as a definite dark acelluar area on specular microscopy (Fig. 4). The preoperative endothelial cell density on specular microscopy was 2717 cells/mm2 and the mean cell size was 368 µm2. At postoperative month three, the mean cell size was 424 µm2 and endothelial cell density had decreased to 2358 cells/mm2. No other changes were observed after that, and the best-corrected visual acuity improved to 0.8 at postoperative month four.


A case of inadvertent anterior chamber and corneal stromal injection with antibiotics during cataract operation.

Ha BJ, Lee SH, Kim YM, Kwon HS, Chu YK, Seo KY - Korean J Ophthalmol (2006)

Diffuse stromal edema (white shaded area) involving the pupil from the 12 to 4 o'clock position.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908860&req=5

Figure 1: Diffuse stromal edema (white shaded area) involving the pupil from the 12 to 4 o'clock position.
Mentions: On postoperative day one, the patient complained of blurred vision and foreign body sensations. Severe corneal edema and Descemet's membrane folds invading the visual axis were seen extending from the 12 to 4 o'clock position (Fig. 1). Inflammatory cells and flares were 3+ in the anterior chamber. Best-corrected visual acuity was 0.2, and intraocular pressure was 18 mmHg by noncontact tonometer. Postoperatively, Cravit® (levofloxacin 0.5%, Santen, Osaka, Japan), 1% prednisolone, and 5% NaCl were administered every two hours. Oral prednisolone (20 mg) and ofloxacin (300 mg) were used as well. A pressure patch with ofloxacin and dexamethasone ointment was administered during sleep. The corneal edema persisted until postoperative day three, and the best-corrected visual acuity decreased to 0.15. The vision improved to 0.4 after two weeks, but the corneal edema persisted without improvement. The patient continued with the original and medications and dosages. On the third postoperative week, the best-corrected visual acuity stabilized at 0.4, and the corneal edema began to resolve. The visual acuity continued to improve to 0.7, and the corneal edema finally resolved four weeks postoperatively. However, the linear Descemet's membrane folds persisted up to postoperative week 16 (Fig. 2, 3). At the same site of the Descemet's membrane fold, corresponding endothelial damage was also observed, manifesting as a definite dark acelluar area on specular microscopy (Fig. 4). The preoperative endothelial cell density on specular microscopy was 2717 cells/mm2 and the mean cell size was 368 µm2. At postoperative month three, the mean cell size was 424 µm2 and endothelial cell density had decreased to 2358 cells/mm2. No other changes were observed after that, and the best-corrected visual acuity improved to 0.8 at postoperative month four.

Bottom Line: Four weeks postoperatively, corneal edema began to reduce significantly.However, some Descemet's membrane folds still remained, and a decrease in the number of endothelial cells was noted by specular microscope.To prevent such mistakes, precise labeling of all solutions and use of different syringe needles should be considered.

View Article: PubMed Central - PubMed

Affiliation: Siloam Eye Hospital, Seoul, Korea.

ABSTRACT

Purpose: To report a case of inadvertent anterior chamber and cornea stromal injection with high dose antibiotics and steroids during cataract operation.

Methods: During cataract operation on a 78 year-old female patient, high dose gentamicin (20 mg/0.5 ml) and dexamethasone (2 mg/0.5 ml) were inadvertently injected into the anterior chamber and cornea stroma when making cornea edema for sealing of the incision sites. Anterior chamber irrigation with balanced salt solution (BSS) was immediately administered. On postoperative day one, extensive cornea edema was noted, and best-corrected visual acuity was 0.2. Descemet's membrane folds were observed around the corneal incision sites. Topical 5% NaCl and 1% prednisolone were started.

Results: Four weeks postoperatively, corneal edema began to reduce significantly. At four months postoperatively, corneal edema fully resolved, and best-corrected visual acuity was 0.8. However, some Descemet's membrane folds still remained, and a decrease in the number of endothelial cells was noted by specular microscope.

Conclusions: In this case involving anterior chamber and cornea stromal injection with high dose antibiotics and steroids, immediate anterior chamber irrigation with balanced salt solution seemed an appropriate management, and the patient's long-term visual acuity appears good. To prevent such mistakes, precise labeling of all solutions and use of different syringe needles should be considered.

Show MeSH
Related in: MedlinePlus