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Gentamicin-induced macular toxicity in 25-gauge sutureless vitrectomy
Dimitrios Brouzas1, Marilita M Moschos, Chryssanthi Koutsandrea
1Department of Ophthalmology, University of Athens Medical School, Athens, Greece.
Cutaneous and Ocular Toxicology
|January 30, 2013
Summary
Gentamicin subconjunctival injection after sutureless vitrectomy can cause severe vision loss due to retinal toxicity. Alternative antibiotics are recommended for sutureless eye surgery to prevent permanent visual impairment.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Toxicology
Background:
- Sutureless 25-gauge pars plana vitrectomy (PPV) is a minimally invasive technique for retinal detachment repair.
- Subconjunctival antibiotics are sometimes used postoperatively to prevent infection.
Observation:
- A 52-year-old male developed visual disturbances two weeks after receiving a subconjunctival gentamicin injection following a 25-gauge sutureless vitrectomy.
- Clinical examination revealed superficial and intraretinal hemorrhages, retinal edema, and cotton-wool patches.
- Fluorescein angiography showed significant retinal vascular non-perfusion, primarily in the posterior pole.
Findings:
- The patient's visual acuity dropped to 1/20 and did not improve during follow-up.
- The observed retinal pathology is consistent with aminoglycoside toxicity.
- This case highlights a potential complication of subconjunctival gentamicin in the context of sutureless PPV.
Implications:
- Aminoglycoside toxicity is a risk associated with subconjunctival gentamicin administration after sutureless vitrectomy.
- Consideration of less toxic antibiotic alternatives is crucial for sutureless ophthalmic procedures.
- Prompt recognition and management are important, as aminoglycoside-induced retinal toxicity can lead to permanent vision loss.
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