Successful Management of Intraoperative Toxic Endothelial Cell Destruction During Routine Manual Small-incision Cataract Surgery

Abstract

Cataract surgery is one of the most commonly performed ophthalmic surgeries worldwide. Stromal hydration is done to improve the integrity of the wound, reform the anterior chamber at the end of the surgery and obtain a water-tight wound closure to reduce the risk of endophthalmitis. At the completion of the surgery, subconjunctival injections of antibiotics and steroids are commonly given to reduce the risk of endophthalmitis. Intracameral injection of antibiotics is the delivery of drugs to prevent endophthalmitis, but if a wrong drug is injected in the anterior chamber, it can result in endothelial and anterior chamber toxicity. Here we report a rare and interesting case of a 60-year-old female who underwent manual small-incision cataract surgery (MSICS) for nuclear sclerosis grade 3. All the steps of the surgery were uneventful. At the end of the surgery, side port stromal hydration was performed, and while injecting intracameral moxifloxacin wrongly, gentamicin and dexamethasone were injected into the stroma and anterior chamber. The patient developed 3 + striate keratopathy postoperatively, which was managed with tapering doses of topical steroids, hypertonic saline, and adjuvant drugs. The endothelial cell toxicity resolved within three weeks, and the patient’s vision returned to 6/6. This case signifies that an intraoperatively wrong drug can be injected intracamerally, resulting in transient endothelial cell toxicity, which, if managed correctly, can give an excellent outcome.