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2018 Agenda and Abstracts | < Previous Next >

2018 OMIG Abstract

Toxic Posterior Segment Syndrome following Dropless Cataract Surgery

Sagar B. Patel, Nikitha Reddy, Yu-Guang He
Department of Ophthalmology, The University of Texas Southwestern Medical Center. Dallas, Texas


Purpose: To report 7 patients with toxic posterior segment syndrome (TPSS) after dropless cataract surgery using contaminated intracameral transzonular compounded triamcinolone and moxifloxacin.

Methods: In this case series, a retrospective chart review was performed of 7 patients who presented to a tertiary referral center with a significant decrease in visual acuity after dropless cataract surgery at an outside surgery center. The patients underwent complete postoperative ophthalmologic exam at presentation and follow-up visits.

Exposure: The patients were all exposed to injections of compounded triamcinolone-moxifloxacin products from the same batch during dropless cataract surgery at one of two identified Dallas surgery centers. The product was locally compounded by Guardian Pharmacy Services. Upon investigation, the product contained poloxamer 407 at a concentration that was greater than the maximum concentration (12%, g/100 mL) approved for ophthalmic topical administration (0.1-0.2%, g/100 mL).

Main Outcome Measures: The postoperative BCVA, SLE, DFE, OCT, and electrophysiology.

Results: All 7 patients experienced symptoms of vision impairment and significant reductions in BCVA of the postoperative affected eye ranging from 20/40 to count fingers at 4 feet, with the average BCVA of 20/220. Other visual symptoms included central blind spot, floaters, color vision disturbances, and halos. All patients experienced symptoms in the postoperative period either immediately or within the first few days. On exam, no ocular inflammation was noted in the affected eyes. In 3 of the 7 cases, foveal retinal pigment epithelium (RPE) changes were noted on DFE. Ellipsoid zone loss was noted on OCT in 5 of the 7 affected eyes. Electrophysiology was tested in 5 of the 7 patients, and all 5 affected eyes demonstrated abnormal responses, including negative ERG (electroretinogram), and large decreases in full-field amplitude, oscillatory potentials, and mfERG. One patient was treated with an Ozurdex implant and Difluprednate taper, but no improvement in visual acuity was noted. Over an average of 6 months of follow-up, no changes were noted in the ophthalmic exams in all cases.

Conclusions: This is the first case series of patients presenting with toxic posterior segment syndrome occurring secondary to intracameral transzonular delivery of compounded triamcinolone-moxifloxacin in dropless cataract surgery. Toxicity of both the inner retina and photoreceptors was confirmed based on abnormalities on OCT and electrophysiology. Clinicians should be aware of this phenomenon and consider the risks and benefits of dropless cataract surgery.

Disclosure: N


2018 Agenda and Abstracts | < Previous Next >