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      Suspected Gentamicin-Induced Retinal Vascular Occlusion after Vitrectomy

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          Abstract

          Retinal vascular occlusion after ocular surgery is a rare but serious complication. A history of cardiovascular diseases, retrobulbar anesthesia injection, high intraocular pressure during the perioperative period, and drug toxicity have been reported as possible causative factors. We report here two cases of multiple retinal vascular occlusions after the subconjunctival injection of gentamicin at the end of uncomplicated 25-gauge vitrectomy. Case 1 was a 61-year-old man who developed a macular hole in the right eye. Phacovitrectomy with gas tamponade was performed. On postoperative day (POD) 1, dot hemorrhage was observed on the temporal side of the optic disk. On POD10, macular whitening, retinal hemorrhage, and multiple occlusion of retinal arteries and veins were observed. Case 2 was a 51-year-old woman who was diagnosed with rhegmatogenous retinal detachment in the right eye and underwent phacovitrectomy with gas tamponade. On POD3, macular whitening with cotton wool spots and retinal hemorrhage were observed with macular ischemia owing to occlusion of retinal arteries and veins. In both cases, subconjunctival injection of gentamicin given at the end of surgery was the most suspected cause of retinal vascular occlusion.

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          Most cited references 10

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          Retinal vascular occlusion after vitrectomy with retrobulbar anesthesia-observational case series and survey of literature.

          Severe postoperative loss of vision has been occasionally reported as a rare complication of retrobulbar anesthesia, and several possible causes have been proposed in the literature. In this work, our own and other investigators' experiences with these complications are surveyed with a view to identifying its pathophysiology.
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            Aminoglycoside toxicity in the treatment of endophthalmitis. The Aminoglycoside Toxicity Study Group.

            Intravitreous aminoglycosides are widely used for the treatment and prophylaxis of endophthalmitis. Because the toxicity of 0.4 mg of gentamicin sulfate is well documented, many surgeons now use amikacin sulfate or low-dose gentamicin to reduce the risk of macular infarction. A survey of retinal specialists has suggested that amikacin or low-dose gentamicin can also cause macular toxic side effects. To further investigate this issue, the critical details of the case histories, findings, and course of 13 patients who received intravitreous injections of 0.2 to 0.4 mg of amikacin sulfate or 0.1 to 0.2 mg of gentamicin sulfate for prophylaxis or treatment of endophthalmitis are summarized. For several patients, complete case histories and a fluorescein angiogram are provided.
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              Aminoglycoside Toxicity in the Treatment of Endophthalmitis

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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2020
                May – August 2020
                11 August 2020
                : 11
                : 2
                : 473-480
                Affiliations
                aDepartment of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
                bDepartment of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
                Author notes
                *Fumiko Murao, Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503 (Japan), murafumitomi@yahoo.co.jp
                Article
                509337 Case Rep Ophthalmol 2020;11:473–480
                10.1159/000509337
                7506252
                © 2020 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Pages: 8
                Categories
                Case Report

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