J Korean Ophthalmol Soc.  2014 Jun;55(6):936-940.

Gentamicin-Induced Macular Toxicity after Transconjunctival Sutureless 23-Gauge Vitrectomy with Prophylactic Subconjunctival Gentamicin Injection

• Jin H
• Kim MH
• Song JH

Abstract

PURPOSE
To report a case of macular toxicity due to gentamicin after transconjunctival 23-gauge sutureless vitrectomy with prophylactic subconjunctival gentamicin injection.
CASE SUMMARY
A 60-year-old female presented to our department with decreased vision in her left eye that had persisted for several months. Best corrected visual acuity (BCVA) was 0.5 in the left eye and she was diagnosed with epiretinal membrane and lamellar macular hole. The patient underwent transconjunctival 23-gauge sutureless vitrectomy with epiretinal membrane removal and intravitreal gas injection. Prophylactic subconjunctival gentamicin injection was given at the end of surgery. After 1 week, fundus examination of the left eye showed multiple retinal hemorrhages around inferior temporal vascular arcade. After six weeks, the patient underwent extracapsular cataract extraction with posterior chamber intraocular lens implantation in the left eye. After cataract surgery, BCVA of the left eye was 0.16 and atrophic change with retinal hemorrhage of the macula was observed on fundus examination of the left eye. Fluorescein angiography revealed multiple occlusion of temporal retinal arteries and capillaries of the macula.
CONCLUSIONS
When a prophylactic subconjunctival drug is injected at the end of transconjunctival sutureless vitrectomy, the drug can inflow into the intraocular space through sutureless sclerotomy sites and induce retinal toxicity.

Keyword

Gentamicin; Retinal toxicity; Sutureless vitrectomy

MeSH Terms

Capillaries
Cataract
Cataract Extraction
Epiretinal Membrane
Female
Fluorescein Angiography
Gentamicins*
Humans
Lens Implantation, Intraocular
Middle Aged
Retinal Artery
Retinal Hemorrhage
Retinal Perforations
Retinaldehyde
Visual Acuity
Vitrectomy*
Gentamicins
Retinaldehyde

Figure

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  Figure 1. Preoperative ocular coherence tomography of the left eye demonstrates epiretinal membrane and lamellar mac-ular hole.

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  Figure 2. Fundus photograph of the left eye after 6 weeks of vitrectomy shows atrophic change in the macula with multiple retinal hemorrhages.

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  Figure 3. Fluorescein angiography of the left eye 3 months after vitrectomy reveals occlusions of the temporal retinal arteries and capillaries in the macula (A: arteriovenous phase; B: late phase).

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  Figure 4. Ocular coherence tomography 3 months after vi-trectomy demonstrates that lamellar macular hole is normal-ized but atrophic thinning of the macula developed on the area corresponding to the ischemia on fluorescein angiography.

Reference

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