Postoperative conjunctival chemosis in cataract surgery caused by subconjunctival gentamicin injection.

A prospective study of 75 patients undergoing cataract surgery was conducted to identify the cause of postoperative conjunctival chemosis seen in patients with cataracts in this department. The patients were split in three groups of 25 each. Group G patients were given a subconjunctival injection of gentamicin at the end of the cataract procedure; group W patients did not receive subconjunctival gentamicin, but a cellulose wick drain was used during the procedure; and Group GW patients received a subconjunctival injection of gentamicin and a wick drain was also used. The incidence, severity, and the duration of chemosis were observed in the three groups. Chemosis was seen only in groups G and GW, and the difference between the number of patients who received gentamicin and those who did not receive gentamicin was significant (p less than 0.001).     

Lacrimal dilator-facilitated incisionless vs. standard sub-Tenon’s block: a randomized,prospective and non-inferiority comparative study

Background/objectivesStandard sub-Tenon’s block (STB) involves incision (dissection) of conjunctiva and Tenon’s capsule with the help of blunt scissors and forceps, insertion of a blunt sub-Tenon’s cannula under the Tenon’s capsule and injection of local anaesthetic agent. STB is frequently associated with minor complications such as chemosis and postoperative subconjunctival haemorrhage but rare sight and life-threatening complications. To reduce these minor complications, several variations of incisionless STB have been described however, there are no comparative data. One such incisionless STB involves the use of lacrimal dilator which is easily available in the operating theatre. We compared incisionless lacrimal dilator-facilitated with the standard STB for effectiveness, chemosis, and postoperative subconjunctival haemorrhage.Subjects/methodsAfter obtaining ethical approval, patients scheduled to undergo elective phacoemulsification cataract surgery were enroled to receive incisionless lacrimal dilator-facilitated STB (Group LD) or a standard STB using Wescott scissors and blunt forceps (Group WS). All patients received 3 mL 2% lidocaine without any adjuvant. No sedation was administered. Demographics of the patients, duration of the procedure, analgesia, akinesia, duration of the procedure intraoperative chemosis, and postoperative subconjunctival haemorrhage were compared.ResultsBoth groups were comparable for demographic data, duration of the procedure, analgesia, and akinesia (p > 0.05). The severity of chemosis and postoperative subconjunctival haemorrhage were significantly lower in Group LD (n = 32) in comparison to Group WS (n = 31) (p < 0.001).ConclusionsIncisionless lacrimal dilator-facilitated STB decreases intraoperative chemosis and postoperative conjunctival haemorrhage in comparison to standard STB. Analgesia and akinesia are comparable in both techniques.Subject terms: Eye diseases, Health care, Oedema, Prognosis     

Randomised single blind trial to compare the toxicity of subconjunctival gentamicin and cefuroxime in cataract surgery.

Comparatively little attention has been paid to the conjunctival toxicity of antibiotics administered at the time of cataract surgery. We have observed the effect of subconjunctival gentamicin and cefuroxime injection, using colour photography in a randomised single blind trial of 121 patients undergoing routine cataract surgery. Our results suggest that a hyperaemic eye is likely to occur about twice as often in patients injected with gentamicin (p less than 0.001). Gentamicin is associated with more pain postoperatively (p less than 0.05). Significant manifestations of gentamicin toxicity are conjunctival oedema and capillary closure. Cefuroxime has some theoretical advantages over gentamicin in its antibacterial spectrum.     

The effects of subconjunctival betamethasone on the blood aqueous barrier following cataract surgery: a double-blind randomised prospective study.

The aim of this double-blind randomised prospective study was to assess the effect of subconjunctival Betnesol (betamethasone sodium phosphate 0.1%) on the recovery of the blood aqueous barrier (BAB) following cataract surgery in uncomplicated eyes. Twenty patients [10 male, mean age 71.4 (SD 12.7) years] admitted for routine cataract surgery were randomised into two groups. All patients recruited into the study were free of other ocular disease and were not taking any anti-inflammatory medication. Group A received a subconjunctival injection of cefuroxime (125 mg) alone while group B received a subconjunctival injection of both cefuroxime and Betnesol. All surgery was performed by a single surgeon using a standardised surgical technique and all patients received the same postoperative medication. The Kowa laser flare cell meter was used to measure aqueous flare and cells preoperatively and on the first, second, and seventh postoperative day, and at 1 and 3 months following surgery. The code was broken only after all patients had been followed-up for 3 months postoperatively. There was no significant difference between the two groups in aqueous flare and cells at any of the postoperative visits. In this study we were unable to demonstrate any beneficial effect of subconjunctival betamethasone on damage to and recovery of the BAB following cataract surgery in the uncomplicated eye.     

A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients

Background:

Pterygium is an ocular surface disorder with prevalence rates ranges from 0.3% to 29% in different parts of the world. Vascular endothelial growth factor (VEGF) has been detected in increased amounts in pterygium epithelium, compared with normal conjunctiva. Bevacizumab is a recombinant, humanized anti-VEGF antibody suggested as a possible adjunctive therapy for pterygium excision that appears to have a role in prevention of recurrence. We conducted this study to evaluate the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients.

Methods:

In this randomized prospective clinical study, the patients were randomized into two groups of 30 patients each. Study group received 1.25 mg/0.05 ml subconjunctival bevacizumab 1 week before pterygium surgery with conjunctival autograft. Control group received 1.25 mg (0.05 ml) subconjunctival normal saline 1 week prior to pterygium surgery with conjunctival autograft. Patients were followed up at day 1, day 7, 1 month and 3 months. The main outcome measures were morphology of pterygium after injection, intra-operative ease, recurrence of pterygia, and any complications.

Results:

After giving bevacizumab, there was statistically significant improvement in grade, color intensity, size of pterygium, and symptoms of patients. Intra-operatively, less bleeding was observed by the surgeon. No statistically significant difference regarding reduction in astigmatism, improvement of visual acuity, and complications were observed in two groups. Recurrence was noted in five patients (8.33%) in total study population at the end of 3 months. It was present in two patients (6.67%) in Group A and three patients (10%) in Group B.

Conclusion:

Single preoperative administration of subconjunctival injection bevacizumab given 1 week before the pterygium excision with conjunctival autograft decreases the vascularity of newly formed blood vessels, hence may decrease recurrence rate though not in our study.     

Effect of subconjunctival steroid injection on intraocular inflammation and blood glucose level after cataract surgery in diabetic patients

PURPOSE: To prospectively evaluate the usefulness of a subconjunctival steroid injection given at the completion of cataract surgery in patients with diabetes mellitus. SETTING: University of Tokyo School of Medicine, Tokyo, Kaiya Eye Clinic, Hamamatsu, and Jyosai Hospital, Tokyo, Japan. METHODS: One hundred four eyes of 104 diabetic patients having routine small incision cataract surgery were randomized into 2 groups. One group received a subconjunctival injection of dexamethasone and the other group did not. Aqueous flare intensity was measured with the laser flare meter preoperatively and 1, 2, 5, 7, and 14 days postoperatively. Another 19 diabetic patients having routine cataract surgery were randomized to receive a subconjunctival steroid injection or not; blood glucose concentration was measured 4 times a day for 3 days postoperatively. RESULTS: There was no significant difference between the 2 groups in aqueous flare values at any postoperative time. The subconjunctival steroid injection induced a transient but significant increase in blood glucose on the day of surgery. CONCLUSION: A subconjunctival steroid injection given at the completion of cataract surgery in diabetic patients had no beneficial effects.     

The role of preoperative subconjunctival mydricaine and topical diclofenac sodium 0.1% in maintaining mydriasis during vitrectomy

PURPOSE: To establish the role of preoperative subconjunctival mydricaine and diclofenac 0.1% in maintaining mydriasis during vitrectomy. METHODS: Fifty-seven patients were entered into the study. All were given cyclopentolate 1% and phenylephrine 2.5% preoperatively. Each patient was randomly allocated to one of three groups. In Group 1, patients received mydricaine by subconjunctival injection and diclofenac 0.1% topically preoperatively. In Group 2, patients received only subconjunctival mydricaine. Group 3 patients received only topical diclofenac preoperatively. Pupil diameter was measured with calipers before and at the end of the operation. RESULTS: There was no statistically significant difference in the change in pupil size between Groups 2 and 3. In all patients in Group 1 (who received both subconjunctival mydricaine and diclofenac preoperatively), pupil size was either maintained or increased after vitrectomy. This result was statistically significant when compared with the other groups (for Group 1 versus Group 2, P<0.005; for Group 1 versus Group 3, P<4.7x10(-06)). CONCLUSION: Topical diclofenac is useful for maintaining pupil size during vitrectomy only when used in conjunction with subconjunctival mydricaine, especially in patients in whom prolonged surgery is anticipated.     

牛磺酸对糖尿病性白内障防治的实验研究

目的探讨牛磺酸对链脲佐菌素（ＳＴＺ）诱导的大鼠糖尿病性白内障的防治效果。方法１４０只ＳＤ大鼠随机分为６组，实验组通过口服、点眼、结膜下注射等途径补充牛磺酸，定期观察晶状体的变化，测定血糖及晶状体中山梨醇、超氧化物歧化酶（ＳＯＤ）、丙二醛（ＭＤＡ）含量并与对照组相比较。结果白内障时晶状体中山梨醇及ＭＤＡ含量显著增加，ＳＯＤ活力明显下降。各牛磺酸用药组晶状体中山梨醇含量无显著性改变，但ＳＯＤ活力明显增加，ＭＤＡ含量明显降低，白内障发生时间推迟，混浊程度减轻，全身应用牛磺酸还可以降低血糖。结论牛磺酸对ＳＴＺ诱导的糖尿病性白内障有一定的防治作用。     

结膜下注射丝裂霉素C的抗瘢痕化效果和安全性研究

目的　研究结膜下注射丝裂霉素Ｃ（ｍｉｔｏｍｙｃｉｎＣ,ＭＭＣ）对兔眼瘢痕化模型的抗瘢痕化效果及对兔眼局部组织的毒副作用,探讨其作为青光眼滤过性手术后抗瘢痕形成辅助用药的可行性及有效性。方法　取１８只健康成年新西兰大白兔,随机分为３组,分别为Ａ组、Ｂ组和Ｃ组,每组１２眼,建立实验性瘢痕化模型。Ａ组术后３ｄ结膜下注射０．４ｇ?Ｌ－１的ＭＭＣ０．３ｍＬ,Ｂ组术中巩膜瓣下放置浸泡０．４ｇ?Ｌ－１ＭＭＣ的棉片５ｍｉｎ,Ｃ组术后３ｄ结膜下注射生理盐水（ｎｏｒｍａｌｓａｌｉｎｅ,ＮＳ）０．３ｍＬ。应用结膜印迹细胞学检查观察结膜损伤情况。分别于术后７ｄ、１４ｄ、２８ｄ分批处死实验兔,摘出眼球,应用免疫组织化学染色检查观察成纤维细胞增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｏｎｃｅｌｌｎｕｃｌｅａｒａｎｔｉｇｅｎ,ＰＣＮＡ）的表达情况,应用光镜观察手术部位的病理改变。结果　术后３组均未出现结膜伤口渗漏,Ａ组、Ｂ组角膜上皮点状缺损于术后１周消失,Ｃ组无角膜上皮点状缺损。结膜印迹细胞学检查显示Ａ组和Ｂ组结膜印迹细胞分级均为２～３级,Ｃ组为２级。术后７ｄ、１４ｄ、２８ｄ光镜下,Ｃ组手术区球结膜下炎性细胞、纤维细胞、新生毛细血管增多,纤维组织增生较Ａ组和Ｂ组显著。免疫组织化学染色结果显示,术后７ｄ,Ａ组、Ｂ组、Ｃ组每高倍视野ＰＣＮＡ阳性细胞计数分别为（１２．８３±２．０８）个、（１４．３７±３．７６）个、（２８．１２±６．７４）个;术后１４ｄ,３组ＰＣＮＡ阳性细胞计数分别为（１３．８１±１．５３）个、（１６．２８±３．７８）个、（２５．６７±４．４５）个;术后２８ｄ,３组ＰＣＮＡ阳性细胞计数分别为（１１．９６±１．４５）个、（１３．０７±２．０４）个、（１７．６９±３．１１）个;相应时间点,Ａ组、Ｂ组ＰＣＮＡ阳性细胞计数均较Ｃ组少（均为Ｐ＝０．０００）,但Ａ组与Ｂ组间差异均无统计学意义（均为Ｐ＞０．０５）。结论　结膜下注射ＭＭＣ能有效抑制手术后术区的瘢痕化,与术中常规应用ＭＭＣ相比,其对结膜的损伤程度无明显差异,对其进一步研究有望为青光眼滤过手术后抗瘢痕化提供一种使用方便、安全、有效的局部用药方式。     

Comparative Study of the Disinfection Effects of Three Types of Conjunctiva Sac Irrigations

 PURPOSE:The antiseptic effectiveness of 5% anerdian III, 0.016% gentamicin, and 0.5% tobramycin solutions in pre-surgical irrigation of conjunctival sac were compared.   METHODS:A total of 295 cataract patients (302 eyes) who had undergone phacoemulsification aspiration combined with intraocular lens insertion (IOL) were recruited in this prospective study. Operative eyes were given 0.3% levofloxacin eye drops for 3 days and then were randomized into three treatment groups:, anerdian (A), gentamicin (B) and tobramycin (C). The patients received conjunctival sac irrigation using the respective solutions at 10 minutes preoperatively. Conjunctival sac sampling was performed before and after irrigation and the samples were used for subsequent bacterial culture and swab tests. The positive culture rate was used as the main outcome. RESULTS: The positive rates of bacterial culture before conjunctival sac irrigationwere 17.31% (18 eyes) in group A, 13.86% (14 eyes) in group B and 17.3% (14 eyes) in group C. Post irrigation, the positive rates in the three groups decreased to 5.76% (6 eyes), 5.94% (6 eyes) and 7.22% (7 eyes), respectively. The positive rates among the three groups did not differ significantly. However, the positive rate in group A only significantly differed before and after the irrigation (P &;lt;0.05). No toxic or allergic reactions were observed on the ocular surface of any patient after irrigation.  CONCLUSION:The antiseptic effects of the three types of conjunctival sac irrigations did not differ.     

Prophylaxis of acute posttraumatic bacterial endophthalmitis with or without combined intraocular antibiotics: a prospective, double-masked randomized pilot study

PURPOSE: The effectiveness of an intraocular injection of combined gentamicin and clindamycin in the prevention of acute posttraumatic bacterial endophthalmitis following penetrating ocular injuries was evaluated in a prospective, double-masked, randomized pilot study. METHODS: Sixty eyes of 60 patients with penetrating ocular injuries were treated at a tertiary care hospital. Following primary repair, the eyes were randomized in two groups. Group 1, the antibiotic injection group (cases), was given an intracameral or intravitreal injection of 0.1 mL antibiotic (40 microg gentamicin and 45 microg clindamycin). Group 2 (balanced saline solution [BSS] injection group [controls]) received intracameral or intravitreal injection of 0.1 mL BSS. All patients received standard prophylactic antibiotic therapy (systemic, subconjunctival, and topical). RESULT: Although the overall incidence of acute posttraumatic bacterial endophthalmitis was 6.6% (4 eyes), the results of three cultures were negative. All endophthalmitis cases occurred in the BSS injection group; however, there was no statistically significant difference between case and control groups (p = 0.11). The incidence rate for those with retained intraocular foreign bodies was 13.3% and for those without foreign bodies was 4.4%. No retinal toxicity was detected. CONCLUSION: Intraocular injection of gentamicin and clindamycin in addition to the other methods of prophylaxis may be an effective modality in the prevention of posttraumatic endophthalmitis. Early results suggest that these antibiotics may have a role as adjunct therapy to primary repair of injured globes without significant side effects at the dosage used.     

Side effects of postoperative administration of methylprednisolone and gentamicin into the posterior sub-Tenon's space

PURPOSE: To assess the incidence of postoperative emetic side effects after the administration of methylprednisolone and gentamicin into the posterior sub-Tenon's space at the end of routine cataract surgery. SETTING: St. Luke's Hospital, Gwardamangia, Malta. METHODS: A double-blind double-armed prospective study comprised 40 patients who had uneventful sutureless phacoemulsification under sub-Tenon's local infiltration of 3 mL of plain lignocaine. At the end of the procedure, Group A (n = 20) had 20 mg/0.5 mL of methylprednisolone and 10 mg/0.5 mL of gentamicin injected into the posterior sub-Tenon's space and Group B (n = 20) had the same combination injected into the anterior sub-Tenon's space. Postoperatively, all patients were assessed for symptoms of nausea, vomiting, and headache. A chi-square test was used to assess the statistical significance of results. RESULTS: Sixty percent in Group A developed postoperative emetic symptoms, headache, or both; 1 patient in Group B developed symptoms. CONCLUSIONS: The administration of methylprednisolone and gentamicin in the posterior sub-Tenon's space was related to a high incidence of side effects including nausea, vomiting, and headache. All adverse effects were self-limiting.     

Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study

Purpose:To describe a novel approach of subconjunctival injection of mitomycin C (MMC) at the end of trabeculectomy and compare it with intraTenon MMC injection.Methods:This pilot study included 40 eyes of 40 patients with uncontrolled primary and secondary glaucoma. Patients below18 years and failed trabeculectomy were excluded. Patients were randomly allocated into groups A and B (20 patients each). Group A patients received subconjunctival MMC injection in the superonasal quadrant at the end of standard trabeculectomy. Group B received an intraTenon MMC injection before the initial conjunctival incision. Outcome measures included intra-ocular pressure (IOP) reduction, bleb morphology, and complication rates. The complete success was defined as an IOP of ≤21 mmHg without antiglaucoma drugs.Results:The mean preoperative IOP of 46.00 ± 11.2 mmHg in group A and 43.05 ± 10.3 mmHg in group B reduced to 12.00 ± 2.41 mmHg (P ≤ 0.001) in group A and 13.65 ± 2.76 mmHg in group B (P ≤ 0.001) at last follow-up. Complete success was 95% and 75% in groups A and B, respectively, 19 months after surgery. Avascular microcystic blebs (70% of group A and 45% of group B) were more common than avascular white blebs (15% in group A and 35% in group B). No intraoperative complications were seen. Postoperative wound leak, hypotony, choroidal detachment, or endophthalmitis were not encountered in any group.Conclusion:A novel approach of subconjunctival MMC application during trabeculectomy is reported. Both approaches appear to be highly effective in reducing IOP in primary and secondary glaucoma with similar safety profiles and bleb morphology. Subconjunctival MMC yielded a greater success rate (95%) compared to the intraTenon MMC group (75%).     

Perilimbal needle manipulation of conjunctival chemosis after cosmetic lower eyelid blepharoplasty

We report an effective treatment procedure for postoperative conjunctival chemosis following cosmetic lower eyelid blepharoplasty. A minimally invasive procedure was used to treat three patients who presented with chronic conjunctival chemosis following lower eyelid blepharoplasty. This procedure utilizes local anesthesia and perilimbal manipulation with a 27-gauge needle. Two months following the procedure, reduction of the chemosis was observed in all three patients. Our cases indicate that perilimbal manipulation with a 27-gauge needle is a viable treatment for this surgical complication.     

A case of ocular benign lymphoid hyperplasia treated with bevacizumab injection

We report the first case of ocular benign lymphoid hyperplasia (BLH) treated with subconjunctival injection of bevacizumab (Avastin). A 27-year-old man presented to our clinic with conjunctival masses and limbal neovascularization. An incisional biopsy yielded the diagnosis of BLH. The patient was subsequently given a subconjunctival injection of bevacizumab (1.25 mg / 0.1 mL). The patient did not experience recurrence or malignant metaplasia during the one-year follow-up period. In patients with conjunctival BLH, subconjunctival injection of bevacizumab can be a useful treatment option in patients unable to undergo a surgical procedure due to limbal neovascularization.     

Injection of cultured autologous fibroblasts into the subconjunctival space of rabbits treated with mitomycin C

PURPOSE: To investigate whether cultured autologous fibroblasts injected into the subconjunctival space of rabbit may be used as a new treatment modality for conjunctival and subconjunctival atrophy caused by mitomycin C (MMC). DESIGN: Animal study. METHODS: Thirty New Zealand White rabbits were divided into three groups of 10 animals. A situation similar to bleb leakage after trabeculectomy with MMC was created by injecting 0.1 ml of MMC 0.05% weekly for three weeks into the subconjunctival space of 30 eyes of these 30 rabbits. The animals were then divided into control, autologous blood injection, and cultured autologous fibroblast injection groups. Conjunctiva changes were then observed, and eyes were enucleated for histopathologic study at one, two, four, six, and eight weeks after surgery in each of the three groups. RESULTS: In the control group, the conjunctiva was thin and transparent, and subconjunctival fibroblasts were hardly visible, with coarsely arranged collagen fibers. In contrast, the autologous fibroblast injection group showed a thickened and less transparent conjunctiva along with packed fibroblasts and collagen fibers. In the autologous blood injection group, the transparency of the conjunctiva and the density of fibroblast and collagen fiber arrangement lay between those of the control and autologous fibroblast injection groups. CONCLUSIONS: Cultured autologous fibroblast injection may be a feasible and effective treatment modality for conjunctival and subconjunctival atrophy caused by MMC.     

三种手术方式治疗青光眼合并白内障疗效的比较

目的 探讨治疗青光眼合并白内障3种手术方式的适应证和临床疗效.方法 对青光眼合并白内障患者135例152只眼进行手术分组:其中30例36只眼先行抗青光眼手术,待白内障发展到一定程度再行白内障手术,即所谓的两阶段手术(A组);87例98只眼行-白联合手术-复合式小梁切除联合小切口白内障晶体吸除+人工晶状体植入术(B组);18例18只眼行单纯白内障手术+人工晶状体植入术(C组).比较不同适应证下3种手术方式的临床疗效,包括眼压控制情况、角膜内皮细胞、视力以及术后并发症等.随访时间(12±1)月.结果 均经统计学处理.结果 手术前后视力≥0.2的眼数3组比较,差异有统计学意义(x~2=16.00,P<0.01).A组与B组手术前后眼压有显著性差异(t_1=1.89,P_1=0.01:t_2=2.87,P_2=0.03),C组手术前后无显著性差异(t=0.43,P=0.78).术前术后角膜内皮细胞数量无显著性差异(P>0.05),3组均未见严重术中并发症,其个A组滤泡形成良好,眼压控制满意,B组术后角膜水肿17例,未特殊处理,1周后全部消退;有2只眼出现瞳孔区纤维膜,滤泡形成欠理想.C组术后视力均显著捉高,有2只眼轻度角膜水肿,有2只眼需加用药物控制眼压,其中1只眼最后接受抗青光眼手术.结论 青光眼合并白内障患者应根据具体情况选择适当的手术方式,以获得较好的视力和眼压控制.     

Preoperative gentamicin eye drops and chlorhexidine solution in cataract surgery. Experimental and clinical results

PURPOSE: 1) To evaluate the effects on the conjunctival flora of gentamicin ophthalmic eye drops 0.3%, given four times in 45 minutes, and a conjunctival rinse with 10 ml chlorhexidine 0.05% solution. 2) To investigate retrospectively the rate of endophthalmitis after cataract operations when these antimicrobials were applied preoperatively. METHODS: Seventy-six patients undergoing standard phacoemulsification operations were enrolled in the experimental part of the study. Cultures were taken preoperatively, 5 minutes after prophylaxis with either chlorhexidine or gentamicin. To assess the combined effects of chlorhexidine and gentamicin, cultures were taken after the cataract operation. Hospital charts were reviewed for cases of endophthalmitis in 1994 and 1995, when this prophylactic protocol was used at the St Erik's cataract surgery department. RESULTS: The conjunctival microflora was significantly suppressed by chlorhexidine rinsing alone (p = 0.001), while no other significant anti-bacterial effects were observed with the experimental prophylaxis. The endophthalmitis rate was 32/12. 806 operations (0.25%). CONCLUSIONS: Topical rinsing with chlorhexidine solution suppresses conjunctival flora in the short term. Combined topical chlorhexidine and gentamicin prophylaxis does not eliminate postoperative endophthalmitis caused by gram-positive bacteria.     

Bee sting-induced ocular changes

A six-year-old boy was stung by a bee on his right cornea. A severe conjunctival injection, chemosis, marked corneal edema, and hyphema developed. A partially dislocated lens, partial iris atrophy, and cataract formation were subsequently noted. He was treated with systemic and topical corticosteroids. Later, the subluxated cataract was removed through the pars plana approach.     

Necrotizing conjunctival ulceration following subconjunctival depot methylprednisolone injection

To report the occurrence of a necrotizing conjunctival ulcer at the site of methylprednisolone injection. A 35-year-old woman underwent a routine extracapsular cataract extraction. Subconjunctival methylprednisolone acetate (Depo-Medrol, Pharmacia & Upjohn, Kalamazoo, MI) was injected at the end of the operation. A necrotizing conjunctival ulcer developed at the site of injection. Necrotic tissue and remnants of the drug were excised, and the conjunctiva healed within 10 days. Postoperative subconjunctival injection of methylprednisolone may cause necrosis and ulceration of the overlying conjunctiva. Subconjunctival and subtendon corticosteroid injections are commonly used in various inflammatory ocular conditions and prophylactically after intraocular operations. We describe a case of conjunctival necrosis at the site of injection, an adverse effect that has been previously reported in only 1 case in the ophthalmological literature.