Toxic anterior segment syndrome

Inadvertent administration of intracameral lidocaine 1% and phenylephrine 2.5% preserved with 10% benzalkonium chloride during cataract surgery

Brett P. Bielory, Ayesha Shariff, Rehan M. Hussain, Jose Antonio Bermudez-Magner, Sander Dubovy, Kendall Donaldson

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: To report 3 patients with corneal decompensation and anterior uveitis within 24 hours of cataract surgery from a single ambulatory surgery center using intracameral lidocaine HCl 1% and phenylephrine 2.5% inadvertently preserved with 10% benzalkonium chloride. Methods: This case series describes 3 patients who underwent traditional cataract extraction with a significant decrease in visual acuity in the immediate postoperative period resulting in secondary surgical intervention for corneal decompensation in 2 patients. Results: All 3 patients experienced a dramatic decrease in visual acuity on the day of surgery, ranging from 20/400 to light perception. They were treated with topical steroids and sodium chloride, with stabilization of vision at 20/60 in 1 patient. The remaining 2 patients did not recover with medical management. One underwent Descemet stripping automated endothelial keratoplasty with placement of the corneal graft on top of Descemet membrane, which could not be removed secondary to extensive fibrosis. The third patient underwent penetrating keratoplasty secondary to deep corneal scarring. Conclusions: This is the first case series of toxic anterior segment syndrome occurring secondary to the use of benzalkonium chloridepreserved intracameral lidocaine and phenylephrine. Clinicians should remain alert to this phenomenon, and should refrain from using intracameral preservatives during cataract surgery.

Original languageEnglish (US)
Pages (from-to)621-624
Number of pages4
JournalCornea
Volume36
Issue number5
DOIs
StatePublished - 2017

Fingerprint

Benzalkonium Compounds
Poisons
Cataract
Ambulatory Surgical Procedures
Visual Acuity
Descemet Stripping Endothelial Keratoplasty
Descemet Membrane
Anterior Uveitis
Penetrating Keratoplasty
Cataract Extraction
Phenylephrine
Lidocaine
lidocaine drug combination phenylephrine
Postoperative Period
Sodium Chloride
Cicatrix
Fibrosis
Steroids
Transplants
Light

Keywords

  • Benzalkonium chloride
  • Intracameral preservatives
  • Lidocaine
  • Phenylephrine
  • Sterile endophthalmitis
  • Toxic anterior segment syndrome

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Toxic anterior segment syndrome : Inadvertent administration of intracameral lidocaine 1% and phenylephrine 2.5% preserved with 10% benzalkonium chloride during cataract surgery. / Bielory, Brett P.; Shariff, Ayesha; Hussain, Rehan M.; Bermudez-Magner, Jose Antonio; Dubovy, Sander; Donaldson, Kendall.

In: Cornea, Vol. 36, No. 5, 2017, p. 621-624.

Research output: Contribution to journalArticle

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abstract = "Purpose: To report 3 patients with corneal decompensation and anterior uveitis within 24 hours of cataract surgery from a single ambulatory surgery center using intracameral lidocaine HCl 1{\%} and phenylephrine 2.5{\%} inadvertently preserved with 10{\%} benzalkonium chloride. Methods: This case series describes 3 patients who underwent traditional cataract extraction with a significant decrease in visual acuity in the immediate postoperative period resulting in secondary surgical intervention for corneal decompensation in 2 patients. Results: All 3 patients experienced a dramatic decrease in visual acuity on the day of surgery, ranging from 20/400 to light perception. They were treated with topical steroids and sodium chloride, with stabilization of vision at 20/60 in 1 patient. The remaining 2 patients did not recover with medical management. One underwent Descemet stripping automated endothelial keratoplasty with placement of the corneal graft on top of Descemet membrane, which could not be removed secondary to extensive fibrosis. The third patient underwent penetrating keratoplasty secondary to deep corneal scarring. Conclusions: This is the first case series of toxic anterior segment syndrome occurring secondary to the use of benzalkonium chloridepreserved intracameral lidocaine and phenylephrine. Clinicians should remain alert to this phenomenon, and should refrain from using intracameral preservatives during cataract surgery.",
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