Serial Swept-Source Optical Coherence Tomography Features of Gentamicin Macular Toxicity: A Glimpse Into the Injury Cascade.

The early clinical manifestations of macular infarction secondary to subconjunctival gentamicin (Gentak; Akorn, Lake Forest, IL) use in an aphakic eye were documented sequentially on swept-source optical coherence tomography (OCT) and fundus fluorescein angiography. The first recorded event after drug toxicity was macular detachment, along with disorganization of outer retinal layers in about 12 hours. The changes in inner retinal layers occurred after 36 hours had elapsed. OCT-documented initial damage to outer retinal layers could be due to the susceptibility of first order retinal neurons, followed by subsequent inner retinal layer involvement and ischemia. This helps in understanding pathogenesis of a catastrophic complication of subconjunctival gentamicin injection commonly used for endophthalmitis prophylaxis. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:456-459.].