Korean J Ophthalmol Vol.20, No.4, 2006 o’clock position involving the visual axis, along with extensive Descemet’s membrane folds. The corneal edema persisted until four weeks postoperatively. We used a hypertonic solution of about 1720 osm/L (5% NaCl) topically to reduce the stromal edema. This concentration is known to be nontoxic,20,21 and the solution was effective in our case. On postoperative week 12, the Descemet’s membrane folds were observed by specular microscopy and persisted 16 weeks after the operation. In our case, corneal edema and the Descemet’s membrane fold were probably due to inadvertent corneal stromal injection with high dose gentamicin and dexamethasone rather than injection directly into the anterior chamber. The duration of exposure and the concentration of the drugs were negligible, due to prompt irrigation of the anterior chamber with balanced salt solution. We found the localized endothelial defect on specular microscopy manifes- ting as a definite dark acelluar area, which corresponded to the area of the Descemet’s membrane fold and site of inadvertent stromal injection. Also, irrigation with a balanced salt solution might play a role in causing corneal edema. On postoperative week four, the corneal edema resolved, and best corrected visual acuity improved to 0.7. Our case showed relatively good visual prognosis despite the high concentration of the injected antibiotics and steroids. This favorable outcome might be due to the immediate irrigation of the anterior chamber with balanced salt solution. As such, long-term endothelial exposure to high dose antibiotics and steroid can be avoided. The immediate irrigation was possible because the balanced salt solution was prepared before the operation. Hansany and Basu22 demonstrated that a 0.1 mg/ml concentration of gentamicin was not toxic to the corneal endothelium until seven days postop, but after seven days corneal endothelial toxicity was demonstrated for that concentration. This study suggested that duration of drug exposure (rather than drug concentration) is also an important factor for corneal endothelial damage. Therefore, considering our case and this study, we can conclude that immediate irrigation of the anterior chamber is important in preventing corneal endothelial damage when high dose antibiotics and steroids are injected in anterior chamber by mistake during cataract or other intraocular surgery. To dilute the intra- stromal antibiotics and steroids, we considered stromal injection of a balanced salt solution, but this was not performed because separation of Descemet’s membrane from stroma can occur. McDonald et al.23 insisted that clear communication between the surgeon and nursing staff, in addition to precise labeling of every injectable solution, is necessary to prevent accidents, such as this. Antibiotics in particular can be confused with a balanced salt solution. In addition, it is wise to draw up injectable antibiotics just before injection, and to use different gauge needles for the different solutions, which could easily be recognized by physician under the microscope. In our case, we reported a favorable visual outcome with 244 immediate irrigation of the anterior chamber with a balanced salt solution after the inadvertent injection of high dose antibiotics and steroids. However, to prevent such an accident during surgery, strict precautions (mentioned previously) and clear communication between surgeons and nursing staff, including scrub nurses, are considered to be of great importance. References 1. Schneider DM, Gills JP, Oyarzun M. 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