Korean J Ophthalmol.  2006 Dec;20(4):241-245. 10.3341/kjo.2006.20.4.241.

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

• KMID: 754591
• DOI: http://doi.org/10.3341/kjo.2006.20.4.241

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.

Keyword

Antibiotics; Balanced salt solution; Corneal edema

MeSH Terms

Visual Acuity
Postoperative Complications/prevention & control
Intraoperative Care/*methods
Injections
Humans
Follow-Up Studies
Female
Endophthalmitis/*prevention & control
Corneal Stroma
Cataract Extraction/*methods
Anti-Bacterial Agents/*administration & dosage/therapeutic use
Anterior Chamber
Aged

Figure

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

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  Fig. 2 Note the whitish Descemet's membrane folds (A) and schematic diagram (B).

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  Fig. 3 A magnified picture of the Descemet's membrane fold (black arrow)

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  Fig. 4 Specular microscopy at the site of Figure 2 (arrow, A; arrow head, B) on 16 weeks postoperatively.

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