A Case of Inadvertent Anterior Chamber and Corneal Stromal Injection with Antibiotics during Cataract Operation 1 2 2 Byoung Jin Ha, MD , Sang Hyup Lee, MD , Yong Min Kim, MD , Hyun Seok Kwon, MD3, Young Kwang Chu, MD1, Kyoung Yul Seo, MD2 Siloam Eye Hospital, Seoul, Korea1 The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea2 Yonsei Eye Clinc3 Purpose: To report a case of inadvertent anterior chamber and cornea stromal injection with high dose antibiotics and steroids during cataract operation. Methods: During cataract operation on a 78 year-old female patient, high dose gentamicin (20 mg/0.5 ml) and dexamethasone (2 mg/0.5 ml) were inadvertently injected into the anterior chamber and cornea stroma when making cornea edema for sealing of the incision sites. Anterior chamber irrigation with balanced salt solution (BSS) was immediately administered. On postoperative day one, extensive cornea edema was noted, and best-corrected visual acuity was 0.2. Descemet’s membrane folds were observed around the corneal incision sites. Topical 5% NaCl and 1% prednisolone were started. Results: Four weeks postoperatively, corneal edema began to reduce significantly. At four months postopera- tively, corneal edema fully resolved, and best-corrected visual acuity was 0.8. However, some Descemet’s membrane folds still remained, and a decrease in the number of endothelial cells was noted by specular microscope. Conclusions: In this case involving anterior chamber and cornea stromal injection with high dose antibiotics and steroids, immediate anterior chamber irrigation with balanced salt solution seemed an appropriate manage- ment, and the patient’s long-term visual acuity appears good. To prevent such mistakes, precise labeling of all solutions and use of different syringe needles should be considered. Korean Journal of Ophthalmology 20(4):241-245, 2006 Key Words: Antibiotics, Balanced salt solution, Corneal edema Anterior chamber injection is a useful drug delivery route for controlling endophthalmitis during intraocular operation. Various drugs, such as antibiotics, steroids, lidocaine, and epinephrine have been used in anterior chamber injection, but can induce endothelial toxicity. Subconjunctival injection of antibiotics and mixing antibiotics with intraocular irrigating solutions are common procedures to prevent postoperative endophthalmitis after cataract operation.1-3 Theoretically, these antibiotics are expected to reduce the risk of endoph- thalmitis, and they have been used clinically for endophthal- mitis treatment, but adequate concentration of the antibiotics (in order to prevent infection without endothelial toxicity) has not yet been fully investigated.4-7 Moreover, there are no case reports dealing with endothelial toxicity after anterior chamber injection of high dose antibiotics. Received: June 30, 2006 Accepted: November 21, 2006 Reprint requests to Young Kwang Chu, MD. Siloam Eye Hospital, #512-5 Deungchon2-Dong, Kangseo-Gu, Seoul 157-032, Korea. Tel: 82-2- 2650-0810, Fax: 82-2-2650-0815, E-mail: drchu@yahoo.com Here, we report a case of inadvertent anterior chamber and corneal stromal injection with high dose antibiotics and steroids during cataract operation, and subsequent manage- ment and complications. Case Report A 78 year-old woman underwent extracapsular cataract extraction with phacoemulsification via temporal clear corneal and a single superior side port incision. An intraocular lens was inserted in the bag, and viscoelastic materials were removed by irrigation and aspiration, without any complica- tions. At the end of the operation, the nurse inadvertently handed over the wrong syringe and, and high dose antibiotics and steroids were inadvertently injected into the anterior chamber and corneal stroma through a 19G needle during the stromal hydration procedure for wound closure at the incision sites. The antibiotics and steroids given were gentamicin (20 mg/0.5 ml) and dexamethasone (2 mg/0.5 ml), originally prepared for subconjunctival injection. About 10 seconds after the injection, we recognized the mistake, and the 241