Andreev A N, Svetozarskiy S N
Volga District Medical Centre under Federal Medical and Biological Agency, 2 Nizhnevolgskaya Naberegnaya, Nizhny Novgorod, Russian Federation, 603001.
Volga District Medical Centre under Federal Medical and Biological Agency, 2 Nizhnevolgskaya Naberegnaya, Nizhny Novgorod, Russian Federation, 603001; Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Sq., Nizhny Novgorod, Russian Federation, 603005.
Vestn Oftalmol. 2018;134(3):73-77. doi: 10.17116/oftalma2018134373.
Serous retinal detachment is a rare postoperative complication of phacoemulsification with intracameral antibiotics. Diagnostic and therapeutic strategy in such cases is not well known.
To present a case of serous retinal detachment after phacoemulsification with intracameral cefuroxime.
A retrospective analysis of the medical record of one patient who had underwent cataract phacoemulsification on both eyes; the follow-up period was 5 months.
Phacoemulsification of noncomplicated cataract with implantation of intraocular lens in the right eye was completed uneventfully; 1 mg of cefuroxime was administered into the anterior chamber at the end of the surgery. In the first day after the surgery visual acuity decreased to 0.2. Serous detachment of retinal pigment and sensory epithelia in the macula area was revealed by optical coherence tomography (OCT). Fluorescein angiography showed no pathological vascular activity. The patient received standard post-surgery therapy supplemented with subtenon triamcinolone, intravenous dexamethasone injections and systemic acetazolamide ingestion. The retinal detachment status was monitored daily by OCT. By day 6 of the follow-up visual acuity recovered to 1.0. After 5 months, inner retinal profile deformation was revealed. The patient's left eye was considered the 'control' eye; phacoemulsification without cefuroxime was performed on it 5 months after the initial surgery, and no complication occurred during the follow-up.
Serous detachment of retinal pigment and sensory epithelia during the early postoperative period after cataract surgery may be caused by a toxic reaction to intracameral cefuroxime even when it's administered in standard dosage. This complication has a favorable prognosis, but requires long term monitoring.
浆液性视网膜脱离是前房内注射抗生素的白内障超声乳化术后一种罕见的并发症。此类病例的诊断和治疗策略尚不明确。
报告一例前房注射头孢呋辛酯后发生浆液性视网膜脱离的病例。
对一名双眼均接受白内障超声乳化手术患者的病历进行回顾性分析；随访期为5个月。
右眼非复杂性白内障超声乳化联合人工晶状体植入术顺利完成；手术结束时向前房内注射1毫克头孢呋辛酯。术后第一天视力降至0.2。光学相干断层扫描（OCT）显示黄斑区视网膜色素上皮和感觉上皮发生浆液性脱离。荧光素血管造影未显示病理性血管活动。患者接受了标准的术后治疗，辅助以球后注射曲安奈德、静脉注射地塞米松及口服乙酰唑胺。每天通过OCT监测视网膜脱离情况。随访第6天时视力恢复至1.0。5个月后，发现视网膜内层形态变形。患者的左眼被视为“对照”眼；在初次手术后5个月对其进行了未注射头孢呋辛酯的超声乳化手术，随访期间未发生并发症。
白内障手术后早期，视网膜色素上皮和感觉上皮的浆液性脱离可能是由前房内注射头孢呋辛酯的毒性反应引起的，即使是按标准剂量给药。这种并发症预后良好，但需要长期监测。
