Gentamicin-induced macular toxicity following flanged intraocular lens fixation

To report a case of gentamicin-induced macular toxicity following subconjunctival injection of gentamicin after flanged intraocular lens (IOL) fixation. A 54-year-old female presented with poor post-operative visual gain following uncomplicated pars plana vitrectomy with dropped nucleus removal and flanged IOL fixation. Clinical examination revealed a patch of retinal opacification at the posterior pole with surrounding cottonwool spots. Fluorescein angiography demonstrated a sharply demarcated area of retinal ischemia with pruning of the surrounding retinal vessels. The findings were suggestive of gentamicin-induced macular toxicity. A short course of systemic corticosteroids failed to bring about significant improvement and the patient developed retinal atrophy in the area. Subconjunctival antibiotics can gain access into the eye in cases with sutureless transconjunctival flanged IOL fixation. Drugs with known intraocular toxicity such as gentamicin should be avoided in such cases.