Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery

PURPOSE: To report cases of intraocular inflammation after intracameral injection of a very high dose of cefuroxime at the end of uneventful cataract surgery. SETTING: Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France. DESIGN: Case series. METHODS: Patients were followed on an outpatient basis and were examined postoperatively at 1 and 5 days and 6 weeks. Central macular thickness, angiography, central corneal thickness (CCT), endothelial cell density (ECD), and electroretinography (ERG) were analyzed to evaluate ocular toxicity. RESULTS: One day postoperatively, the mean corrected distance visual acuity (CDVA) was 0.95 logMAR +/- 0.40 (SD). All the cases had moderate anterior inflammation. Retinal optical coherence tomography scans systematically showed extensive macular edema (mean 843.2 +/- 212.7 mu m) associated with a large serous retinal detachment. Fluorescein angiograms showed diffuse leakage without abnormal retinal perfusion. At 5 days, the mean CDVA improved significantly to 0.52 +/- 0.29 logMAR (P<.005), as did the macular edema and serous retinal detachment (mean 339.4 +/- 138.3 mu m) (P=.005). At 6 weeks, the mean CDVA reached 0.09 +/- 0.06 logMAR. Modifications in CCT and ECD were similar to those observed after uneventful phacoemulsification. The macular thickness (mean 288.4 +/- 22.6 mu m) and profile returned to normal in all patients, although ERG recordings showed reduced rod photoreceptor cell function (P<.05). CONCLUSIONS: Intracameral injection of high doses of cefuroxime induced anterior and posterior inflammation. Without surgical intervention, the final visual outcome was satisfactory in all cases. Long-term retinal function, however, must be assessed through repeated ERG recordings.