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Brief Report |

Toxic Keratopathy Following the Use of Alcohol-Containing Antiseptics in Nonocular Surgery

Hsin-Yu Liu, MD1; Po-Ting Yeh, MD1; Kuan-Ting Kuo, MD2; Jen-Yu Huang, MD1; Chang-Ping Lin, MD1; Yu-Chih Hou, MD1
[+] Author Affiliations
1Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
2Department of Pathology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
JAMA Ophthalmol. 2016;134(4):449-452. doi:10.1001/jamaophthalmol.2016.0001.
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Importance  Corneal abrasion is the most common ocular complication associated with nonocular surgery, but toxic keratopathy is rare.

Observation  Three patients developed severe toxic keratopathy after orofacial surgery on the left side with general anesthesia. All patients underwent surgery in the right lateral tilt position with ocular protection but reported irritation and redness in their right eyes after the operation. Alcohol-containing antiseptic solutions were used for presurgical preparation. Ophthalmic examination showed decreased visual acuity ranging from 20/100 to 20/400, corneal edema and opacity, anterior chamber reaction, or stromal neovascularization in the patients’ right eyes. Confocal microscopy showed moderate to severe loss of corneal endothelial cells in all patients. Despite prompt treatment with topical corticosteroids, these 3 patients eventually required cataract surgery, endothelial keratoplasty, or penetrating keratoplasty, respectively. After the operation, the patients’ visual acuity improved to 20/30 or 20/40. Data analysis was conducted from December 6, 2010, to June 15, 2015.

Conclusions and Relevance  Alcohol-containing antiseptic solutions may cause severe toxic keratopathy; this possibility should be considered in orofacial surgery management. Using alcohol-free antiseptic solutions in the periocular region and taking measures to protect the dependent eye in the lateral tilt position may reduce the risk of severe corneal injury.

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Figure 1.
Biomicroscopy Findings

A and B, Faint corneal opacities seen in patient 1. C, Corneal edema seen in patient 2. D, Clear graft after endothelial keratoplasty in patient 2. E, Corneal edema with band keratopathy in patient 3. F, Clear graft after penetrating keratoplasty in patient 3.

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Figure 2.
Confocal Microscopy Findings

A and B, Prominent nuclei in corneal endothelium in the right eye compared with the left eye in patient 1. C and D, Marked polymegathesim in corneal endothelium in the right eye compared with the left eye in patient 2. E and F, Marked pleomorphism in corneal endothelium in the right eye compared with the left eye in patient 3.

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