Gentamicin-induced macular infarction in transconjunctival sutureless 25-gauge vitrectomy

State Gentamicin antibiotic prophylaxis is contraindicated in 25 gauge Transconjunctival Sutureless Vitrectomy.

A 75-year-old diabetic woman was affected by glaucoma and mild diabetic retinopathy in both eyes, and epiretinal membrane in the left eye. A 25-gauge Transconjunctival Sutureless Vitrectomy (TSV) was performed with self-sealing transconjunctival scletomies of the left eye. Post-operation antibiotic prophylaxis was obtained by subconconjunctival injection of Gentamicin sulfate (0.4 mg/ml) adjacent to scletomies.

A month after the operation visual acuity had not recovered. Fluorescein angiography detected occlusion of perifoveal capillaries.

Antibiotics, in particular gentamicin, have the potential to cause significant ocular toxicity when they gain access to the inside of the eye, through thinned sclera or sutureless sclerotomies of TSV.