J Korean Ophthalmol Soc.  2013 Jul;54(7):1126-1129. 10.3341/jkos.2013.54.7.1126.

Ischemic Retinopathy Due to Suspicious Gentamicin Retinal Toxicity after Primary Repair of Scleral Laceration

• Kim JM
• Ghim WH
• Cho WH
• Kyung SE
• Chang MH

• KMID: 2217427
• DOI: http://doi.org/10.3341/jkos.2013.54.7.1126

Abstract

PURPOSE
To report a case of ischemic retinopathy due to suspicious gentamicin retinal toxicity after primary repair of a scleral laceration.
CASE SUMMARY
A 45-year-old man presented to our department with decreasing vision in his right eye after ocular trauma. Best corrected visual acuity (BCVA) was 0.02 in the right eye and slit lamp examination revealed scleral laceration. Both intravenous and topical antibiotics (10% cefazolin and 2% gentamicin) were immediately administered. On intraoperative examination, a scleral laceration located 5 mm to 11 mm from nasal limbus, prolapsed vitreous body and partial division of medial rectus muscle were observed. After irrigation with gentamincin 0.2% around the wound, primary repair was performed. On postoperative day 3, fundus examination revealed a retinal break, barrier laser was performed. On postoperative day 4, diffuse retinal edema with intraretinal hemorrhage was observed as well as, superonasal ghost vessels. Subsequently, fluorescein angiography showed diffuse leakage of retinal vessels and a nonperfusion area at the periphery, especially on the nasal side. As vitreous opacity became worse, the patient underwent pars plana vitrectomy with endolaser. One month later, vitreous cavity was clearer and best visual acuity was 0.2.
CONCLUSIONS
Large doses of intraocular gentamicin ccan cause retinal toxicity. Increased gentamicin application through a scleral laceration may lead to toxic antibiotic levels. When a scleral laceration wound irrigation is performed, precautions are necessary to prevent retinal ischemia associated with gentamicin toxicity.

Keyword

Gentamicin; Ischemic retinopathy; Scleral laceration; Toxicity

MeSH Terms

Anti-Bacterial Agents
Cefazolin
Eye
Fluorescein Angiography
Gentamicins
Hemorrhage
Humans
Ischemia
Lacerations
Muscles
Papilledema
Retinal Perforations
Retinal Vessels
Retinaldehyde
Vision, Ocular
Visual Acuity
Vitrectomy
Vitreous Body
Anti-Bacterial Agents
Cefazolin
Gentamicins
Retinaldehyde

Figure

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  Figure 1. (A) A photograph of the right eye before primary repair shows a full-thickness scleral laceration, partial division of medial rectus muscle and prolapsed vitreous body. (B) Irrigation with 10 ml of gentamicin 0.2% was performed around sclera laceration.

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  Figure 2. Fundus photograph taken 3 days later primay repair of sclera laceration showing retinal edema, intraretinal hemor-rhage, and ghost vessels.

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  Figure 3. (A, B) Fluorescein angiography shows diffuse leak-age of the retinal vessels in the early phase. (C, D) In the late phase, nonperfusion area is seen in the nasal periphery.

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  Figure 4. Fundus photograph taken 1 month after the pars pla-na vitrectomy. Endolaser showing clear vitreous and de-creased intraretinal hemorrhage.

Reference

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