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      Acute macular edema and serous detachment on the first day after phacoemulsification surgery: A case report

      case-report

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          Abstract

          Purpose

          To report a case of an acute macular edema with serous retinal detachment on the first day after uncomplicated phacoemulsification surgery with the use of a standard dose of intracameral cefuroxime at the end of the surgery.

          Observations

          A 46-year-old man underwent a technically uneventful right eye phacoemulsification surgery using a standard dose (1mg/0.1mL) of cefuroxime solution injected into the anterior chamber at the end of the surgery. Serous macular edema and detachment were in our case observed on the first post-operative day. Without surgical intervention fast clinical recovery was observed and best corrected visual acuity improved to the final visual outcome of 1.0, which was satisfactory 10 days after surgery.

          Conclusions and Importance

          Acute serous macular detachment and edema should be considered in cases of poor visual acuity in the early postoperative period. The role of a standard dose of cefuroxime toxicity should be more widely explored and discussed.

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          Most cited references40

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          Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors.

          ESCRS Endophthalmitis Study Group (2007)
          To identify risk factors and describe the effects of antibiotic prophylaxis on the incidence of postoperative endophthalmitis after cataract surgery based on analysis of the findings of the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study. Twenty-four ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom. A prospective randomized partially masked multicenter cataract surgery study recruited 16 603 patients. The study was based on a 2 x 2 factorial design, with intracameral cefuroxime and topical perioperative levofloxacin factors resulting in 4 treatment groups. The comparison of case and non-case data was performed using multivariable logistic regression analyses. Odds ratios (ORs) associated with treatment effects and other risk factors were estimated. Twenty-nine patients presented with endophthalmitis, of whom 20 were classified as having proven infective endophthalmitis. The absence of an intracameral cefuroxime prophylactic regimen at 1 mg in 0.1 mL normal saline was associated with a 4.92-fold increase (95% confidence interval [CI], 1.87-12.9) in the risk for total postoperative endophthalmitis. In addition, the use of clear corneal incisions (CCIs) compared to scleral tunnels was associated with a 5.88-fold increase (95% CI, 1.34-25.9) in risk and the use of silicone intraocular lens (IOL) optic material compared to acrylic with a 3.13-fold increase (95% CI, 1.47-6.67). The presence of surgical complications increased the risk for total endophthalmitis 4.95-fold (95% CI, 1.68-14.6), and more experienced surgeons were more likely to be associated with endophthalmitis cases. When considering only proven infective endophthalmitis cases, the absence of cefuroxime and the use of silicone IOL optic material were significantly associated with an increased risk, and there was evidence that men were more predisposed to infection (OR, 2.70; 95% CI, 1.07-6.8). Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.
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            Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment.

            Aaron Ponce, T. J. Kim, Sarah B. Henderson … (2007)
            To characterize the incidence, duration, and risk factors for and outcome of cystoid macular edema (CME) after cataract surgery and investigate the effects of treatment regimens on visual outcome and duration. University-based comprehensive ophthalmology practice. This study included 1659 consecutive cataract surgeries performed by residents between 2001 and 2006. Cases were classified according to the presence of CME. Subset analysis excluded patients with diabetes mellitus (DM). The CME groups were analyzed according to type of treatment to compare duration of CME and final best corrected visual acuity. The incidence of postoperative CME was 2.35% (39/1659), and history of retinal vein occlusion (RVO) was predictive of postoperative CME (odds ratio [OR], 47.12; P<.001). When patients with DM were excluded, the incidence of CME was 2.14% (29/1357) and history of RVO (OR, 31.75; P<.001), epiretinal membrane (ERM) (OR, 4.93; P<.03), and preoperative prostaglandin use (OR, 12.45; P<.04) were predictive of postoperative CME. Patients with DM and/or intraoperative complications did not have an increased risk for CME when treated with prophylactic postoperative nonsteroidal antiinflammatory drugs (NSAIDs) for 3 months. Groups treated with NSAIDs plus a steroid had significantly shorter resolution times than the untreated group (P = .004). A history of RVO, ERM, and preoperative prostaglandin use were associated with an increased risk for pseudophakic CME. Treatment with NSAIDs plus steroids was associated with faster resolution of CME than no treatment. Treating high-risk patients with NSAIDs after cataract surgery decreases the incidence of postoperative CME to that of patients who are not at high risk.
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              ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study.

              Magnus Peterson, , Crawford W. Revie … (2006)
              To report results in the European Society of Cataract & Refractive Surgeons (ESCRS) multicenter study of the prophylaxis of endophthalmitis after cataract surgery. Twenty-four ophthalmology units and eye clinics in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain, Turkey, and the United Kingdom, with an administrative office in Ireland, coordinating center in England, and data management and statistical unit in Scotland. This partially masked randomized placebo-controlled multinational clinical study to evaluate prospectively the prophylactic effect of intracameral cefuroxime injection and/or perioperative levofloxacin eyedrops on the incidence of endophthalmitis after phacoemulsification cataract surgery began in September 2003 and was terminated early in January 2006. The study used random allocation of patients in a 2 x 2 factorial design. By the end of 2005, complete follow-up records had been received for 13 698 study patients. Such a clear beneficial effect from the use of intracameral cefuroxime had been observed that it was agreed it would be unethical to continue the study and to wait for the completion of all follow-up procedures before reporting this important result. If total reported cases of endophthalmitis are considered, the incidence rate observed in those treatment groups not receiving cefuroxime prophylaxis (23 cases in 6862 patients) was almost 5 times as high (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.74-12.08; P = .002) as that in the groups receiving this treatment (5 cases in 6836 patients). If only cases proved to be due to infection are considered, the rate was more than 5 times as high (OR, 5.32; 95% CI, 1.55-18.26; P = .008) in the treatment groups not receiving cefuroxime. Although the use of perioperative levofloxacin eyedrops as prophylaxis was also associated with a reduction in the observed incidence rate of postoperative endophthalmitis, this effect was smaller and was not statistically significant, whether total reported cases or only cases proven to be due to infection are used in calculating the rates. As not all follow-up procedures are complete, it is possible that further cases of endophthalmitis may be reported; however, it is not expected that this will alter the main conclusion. Nevertheless, it is anticipated that successful completion of follow-up procedures in all patients will increase the total number in the study to approximately 16,000. Intracameral cefuroxime administered at the time of surgery significantly reduced the risk for developing endophthalmitis after cataract surgery.
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                Author and article information

                Contributors
                Edyta Chlasta-Twardzik
                Anna Nowińska
                Edward Wylęgała
                Journal
                Journal ID (nlm-ta): Am J Ophthalmol Case Rep
                Journal ID (iso-abbrev): Am J Ophthalmol Case Rep
                Title: American Journal of Ophthalmology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2451-9936
                Publication date PMC-release: 01 September 2020
                Publication date Collection: December 2020
                Publication date (Electronic): 01 September 2020
                Volume: 20
                Electronic Location Identifier: 100905
                Affiliations
                [a ]Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, Poland
                [b ]Clinical Department of Ophthalmology, District Railway Hospital in Katowice, Poland
                Author notes
                [∗ ]Corresponding author. Department of Ophthalmology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Ul. Panewnicka 65, 40-760, Katowice, Poland. edyta.chlasta@ 123456gmail.com
                Article
                Publisher ID: S2451-9936(20)30220-6 Publisher ID: 100905
                DOI: 10.1016/j.ajoc.2020.100905
                PMC ID: 7486609
                SO-VID: 3f1dfbce-cb0f-4926-aee1-c070c65b4013
                Copyright © © 2020 The Authors. Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 10 December 2019
                Date revision received : 14 August 2020
                Date accepted : 22 August 2020
                Categories
                Subject: Case Report

                Keywords: phacoemulsification,post-operative complications,macular edema,macular detachment,retinal toxicity
                Data availability:
                Keywords: phacoemulsification, post-operative complications, macular edema, macular detachment, retinal toxicity

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