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

Hosung Jin; Min Ho Kim; Ji Hun Song

doi:10.3341/jkos.2014.55.6.936

Journal List > J Korean Ophthalmol Soc > v.55(6) > 1010007

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Jin, Kim, and Song: Gentamicin-Induced Macular Toxicity after Transconjunctival Sutureless 23-Gauge Vitrectomy with Prophylactic Subconjunctival Gentamicin Injection

Case Report

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

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.6.936

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

Hosung Jin, MD, Min Ho Kim, MD, Ji Hun Song, MD

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

Address reprint requests to Ji Hun Song, MD, Department of Ophthalmology, Ajou University Medical Center, #164 World cup-ro, Yeongtong-gu, Suwon 443-380, Korea, Tel: 82-31-219-5261, Fax: 82-31-219-5909, E-mail: dreyesong@naver.com

Received 28 December 2013 Revised 12 February 2014 Accepted 23 May 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of macular toxicity due to gentamicin after transconjunctival 23-gauge sutureless vitrectomy with pro-phylactic 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 ob-served 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.

Keywords: Gentamicin, Retinal toxicity, Sutureless vitrectomy

References

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Figure 1.

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

Figure 2.

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

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).

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.

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