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Kim, Kim, and Ahn: A Case of Corneal Endothelial Damage by 5-Fluorouracil Inflow Into Anterior Chamber After Subconjunctival Injection
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2010; 51(9): 1287-1291.

Published online: 30 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.9.1287

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

Dae Hee Kim, MD, Min Ho Kim, MD, Jae Hong Ahn, MD

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea.

Address reprint requests to Jae Hong Ahn, MD. Department of Ophthalmology, Ajou University Hospital, San 5 Wonchon-dong, Yeongtong-gu, Suwon 443-721, Korea. Tel: 82-31-219-5673, Fax: 82-31-219-5259, chrisahn@ajou.ac.kr

Received 17 March 2010       Accepted 23 March 2010

Copyright © 2010 The Korean Ophthalmological Society

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.

Keywords: Corneal endothelium, Needling, Subconjunctival injection, Trabeculectomy, 5-Fluorouracil (5-FU)

Figures and Tables

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.
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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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Table 1
Numeric data from specular microscopy according to timeline
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Note that corneal endothelial findings became worse 2 months after inadvertent 5-FU inflow compared with preoperative findings. Afterwards, corneal endothelial findings got improved at 3 months after inadvertent 5-FU inflow, but compared to the preoperative status, the corneal endothelial density was not restored.

References

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