Structural and Functional Insight into Intracameral Cefuroxime Ocular Toxic Syndrome (ICOTS) in Eyes with Disrupted Intraocular Barrier.
Academic Article
Overview
abstract
INTRODUCTION: Intracameral cefuroxime is commonly used as a prophylaxis against endophthalmitis following cataract surgery. While its effectiveness is well-documented, concerns remain regarding potential toxicity. Intracameral cefuroxime ocular toxic syndrome (ICOTS) is characterized by acute, extensive, and serous retinal detachment that usually resolves spontaneously. However, the long-term effects of ICOTS have not yet been studied. This study aims to provide new insights into ICOTS using multimodal imaging, retinal electrophysiology, and perimetry to assess both acute and chronic functional and structural changes in eyes with a disrupted intraocular vitreous barrier. METHODS: This retrospective case series included four patients affected by ICOTS who underwent cataract surgery with standard-dose intracameral cefuroxime (1.0 mg/0.1 ml). Three patients had previously undergone pars-plana vitrectomy and one patient had undergone anterior vitrectomy. Patients were followed up to 1 year after surgery. Evaluations included optical coherence tomography (OCT), ultra-wide-field (UWF) OCT-angiography (OCTA), automated perimetry, and multifocal electroretinography (ERG) at the preoperative visit (T0) and at 1 day (T1), 1 week (T2), 1 month (T3), 6 months (T4), and 1 year (T5) after cataract surgery. RESULTS: At T1, all patients had acute extensive serous retinal detachments. UWF-OCTA revealed increased superficial vessel density during the acute phase, with only partial restoration at follow-up. Two cases had permanent structural damage to the outer retina. Functional assessments showed transient changes in multifocal ERG responses, returning to near-normal levels within T3. Best-corrected visual acuity worsened at T1 and improved after the subretinal fluid resolution (T2). CONCLUSION: Intracameral cefuroxime ocular toxic syndrome may induce persistent retinal changes despite fluid resolution in eyes with a disrupted intraocular barrier due to prior vitrectomy. Early OCT assessment can help to identify this condition. Further investigation, incorporating UWF-OCTA and ERG for a comprehensive assessment of ICOTS, along with revised informed consent protocols for patients undergoing cataract surgery with this antibiotic prophylaxis, may be indicated when risk factors are identified.
