Toxic retinopathy after phacoemulsification when the cefuroxime dilution is correct

To determine the clinical characteristics and outcomes of patients with toxic retinopathy after phacoemulsification and intraocular lens implantation when the correct cefuroxime dilution is administered.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Prospective case series.

Patients developing toxic retinopathy after phacoemulsification between January 2016 and April 2017 were observed. All patients received an anterior chamber injection of correctly diluted cefuroxime at the end of the surgery.

The study evaluated 20 patients (20 eyes). At the 1-day follow-up, the mean logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) decreased to 0.78 logMAR ± 0.31 (SD) with no significant difference compared with the preoperative CDVA of 0.71 ± 0.34 logMAR (P = .535). Spectral-domain optical coherence tomography (SD-OCT) showed cystoid macular edema (CME) with extensive serous neurosensory retinal detachment (RD) at the posterior pole. At the 1-week follow-up, the mean CDVA improved to 0.13 ± 0.80 logMAR and the improvement was significant compared with the preoperative and 1-day postoperative logMAR CDVA (P < .001). The SD-OCT showed regression of CME and recovery of RD.

When the drug dilution is correct, there is still a possibility of sporadic cefuroxime toxic maculopathy after intracameral injection of cefuroxime. This toxicity might be related to transient retinal pigment epithelium sodium-potassium pump dysfunction resulting from a large injection volume of a standard dose concentration or individual differences in conventional drug dose tolerance.