Ocular Toxicity After Inadvertent Intracameral Injection of High Dose of Cefuroxime During Cataract Surgery: A Case Series

Abstract

Anterior and posterior inflammation has been described after intracameral injection of high dose of cefuroxime. In this study, 10 mg to 12.5 mg of intracameral cefuroxime is shown to be, principally, toxic to the retina with transient or permanent retinal changes on optical coherence tomography which correlate with visual outcomes postoperatively. Protocols to avoid dilution errors should be available in theaters during cataract surgery where such commercial preparations are not available.

High dose cefuroxime causing retinal toxicity in a patient undergoing trabeculectomy

“… 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…”

Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update

“…Intracameral vancomycin is associated with hemorrhagic occlusive retinal vasculitis (HORV) (48), and retinal toxicity is also associated with cefuroxime at high (49,50) and standard intracameral doses (51).…”

Study of the Effectiveness of Precision Doses of Antibiotics in the Treatment of Induced Acute Bacterial Postoperative Endophthalmitis in an Experiment

“…Эти проявления встречаются после однократного внутрикамерного или трансцилиарного введения стандартных, а в некоторых случаях избыточных доз гентамицина и цефуроксима и проявляются в виде неинфекционного панувеита, синдрома ретинальной ишемии, атрофии зрительного нерва, геморрагических нейроретиноваскулитов и др. [16][17][18]. Эти данные еще раз подтверждают необходимость прецизионного, строго дозированного использования антибиотиков в офтальмологии, особенно в тех случаях, когда речь идет о максимальном сохранении зрительных функций.…”