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S. P. Shah, A. Kaines, S. Reddy, S. D. Schwartz; Catastrophic Visual Loss Following Sutureless 23-gauge Pars Plana Vitrectomy From Aminoglyciside Toxicity. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4207.
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To report on a case of retinal toxicity in the setting of microincisional sutureless pars plana vitrectomy for a macula on retinal detachment.
A single case was retrospectively reviewed.
A 66 year old female was referred following surgery for a left macula on retinal detachment. Preoperative visual acuity was OD 20/30 and OS 20/40. She had undergone routine uncomplicated 23-gauge pars plana vitrectomy with gas tamponade. The ports were shelved and at the end of surgery were watertight and left unsutured. A routine subconjunctival gentamicin injection in the inferonasal quadrant away from the vitrectomy ports was administered. Following surgery, her vision did not improve beyond 20/200 in the affected eye.Fluorescin angiography three months after surgery revealed macular infarction of the retinal circulation. Spectral domain optical coherence tomography shows inner retina vacuolation and early inner retinal atrophy. Follow up eleven months later showed persistence of non perfusion and optic atrophy. Autofluorescence imaging shows a reduction of the foveal dark area and some mild RPE hyperfluorence.
This report highlights the dangers of subconjunctival retinal toxins in the setting of sutureless microincisional vitrectomy and correlates aminoglycoside toxicity with the new autofluorescence and OCT findings. The visual outcome of this case suggests that less toxic endophthalmitis prophylaxis should be used.
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