J Korean Ophthalmol Soc.  2010 Sep;51(9):1287-1291. 10.3341/jkos.2010.51.9.1287.

A Case of Corneal Endothelial Damage by 5-Fluorouracil Inflow Into Anterior Chamber After Subconjunctival Injection

• Kim DH
• Kim MH
• Ahn JH

• KMID: 2122299
• DOI: http://doi.org/10.3341/jkos.2010.51.9.1287

Abstract

PURPOSE
To present a case of corneal endothelial damage caused by inflow of 5-FU after subconjunctival 5-FU injection in a patient undergoing trabeculectomy.
CASE SUMMARY
A 65-year-old female patient diagnosed with chronic angle-closure glaucoma underwent trabeculectomy using mitomycin C. Three weeks after the surgery, her intraocular pressure (IOP) elevated, and the follicles had disappeared by trabeculectomy. Subsequently, subconjunctival 5-FU injection was performed. Following the fourth injection, visual acuity abruptly decreased, and corneal edema was observed. Upon presumption of inflow of 5-FU into the anterior chamber, anterior chamber irrigation was performed within 40 minutes. On postoperative day 1, visual acuity decreased from 0.8 to counting fingers, and diffuse corneal edema and anterior capsular opacity of the lens were noted. Three months after the irrigation, visual acuity improved to 0.8. Corneal edema and capsular opacity also improved, however the density of the corneal endothelial count decreased.
CONCLUSIONS
Inflow of 5-FU into the anterior chamber can cause corneal and lenticular toxicity. Anterior chamber irrigation is considered necessary to prevent 5-FU toxicity.

Keyword

Corneal endothelium; Needling; Subconjunctival injection; Trabeculectomy; 5-Fluorouracil (5-FU)

MeSH Terms

Aged
Anterior Chamber
Corneal Edema
Endothelium, Corneal
Female
Fingers
Fluorouracil
Glaucoma, Angle-Closure
Humans
Intraocular Pressure
Mitomycin
Trabeculectomy
Visual Acuity
Fluorouracil
Mitomycin

Figure

• 

  Figure 1 Anterior segment findings of the patient, 2 months after inadvertent 5-FU inflow. (A) The upper part of the cornea is clear and the lens shows negligible anterior capsular opacities. (B) The lower segment of the cornea shows Descemet's folds.

• 

  Figure 2 Specular microscopic findings according to timeline. (A) Preoperative specular microscopic findings. (B) Specular microscopic findings 2 months after inadvertent 5-FU inflow. Decreased cell density and obscured margins between cells were noted. (C) Specular microscopic findings 3 months after 5-FU inflow. Compared with preoperative findings, cell density was decreased, but margins between cells became clearer.

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