CASE REPORT article
Front. Ophthalmol.
Sec. Surgical Ophthalmology
Case Report: Maculopathy Following Standard Dose Intracameral Cefuroxime Injection During ICL Surgery
Zhenlin Lin 1
Li Huang 1
Deli Li 2
Shouchun Yi 1
Jingning Weng 1
1. Fuzhou Aier Eye Hospital, Fuzhou, China
2. Ningde Aier Eye Hospital, Ningde, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Purpose To describe two rare occurrences of acute toxic maculopathy, specifically Intracameral Cefuroxime Ocular Toxic Syndrome (ICOTS), following uncomplicated posterior-chamber toric phakic implantable collamer lens (TICL) surgery despite the administration of a standard dosage of cefuroxime. Materials and Methods This case report identified two patients from a clinical volume of 1,590 eyes treated between 2021 and 2024. Inclusion criteria consisted of patients undergoing bilateral TICL implantation with intracameral cefuroxime who presented with unexpected visual disturbances on postoperative day 1. To isolate cefuroxime as the primary toxic factor, exclusion criteria included systemic comorbidities (such as diabetes mellitus), pre-existing ocular pathologies (including uveitis, macular degeneration, or prior retinal detachment), history of prostaglandin analog use, or baseline structural abnormalities on preoperative optical coherence tomography (OCT). Clinical evaluation included UDVA, BCVA, and SD-OCT imaging. Results Two female patients (aged 29 and 32) underwent bilateral TICL surgery with 0.1 mL of 10 g/L intracameral cefuroxime administered at the conclusion of the procedure. On postoperative day 1, both patients presented with unilateral vision loss (BCVA 20/32 and 20/80, respectively) and reported dim or distorted vision. SD-OCT revealed macular edema and subretinal fluid (SRF). Following conventional postoperative treatment with topical steroids and nonsteroidal anti-inflammatory drugs, complete absorption of SRF was achieved within two weeks to one month, and BCVA improved to 20/16 and 20/20, respectively. Conclusion While intracameral cefuroxime is a highly effective prophylactic against endophthalmitis, it may cause sporadic toxic maculopathy even at standard doses during ICL surgery. Unlike typical post-cataract inflammatory edema, ICOTS presents acutely on day 1. Surgeons should maintain a high index of suspicion and utilize early OCT imaging for unexpected postoperative visual disturbances.
Summary
Keywords
ICL surgery, Intracameral cefuroxime, Intracameral Cefuroxime Ocular Toxic Syndrome (ICOTS), Macular Edema, Subretinal Fluid, Toxic maculopathy
Received
30 December 2025
Accepted
17 February 2026
Copyright
© 2026 Lin, Huang, Li, Yi and Weng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jingning Weng
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.