A case of aminoglycosides induced retinal toxicity treated with megadoses of steroids and an intravitreal dexamethasone implant (Ozurdex®)

Abstract

Case report

The case is described of a patient who had a sudden loss of vision in her right eye after glaucoma surgery. A diagnosis of retinal toxicity due to tobramycin (an aminoglycoside) was reached, which was characterised by retinal whitening with a red cherry stain, macular oedema, and vasculitis that progressed to papillary and macular atrophy with arteriolar sclerosis. Given the severity of symptoms an early attempt was made with megadoses of steroids and an intravitreal dexamethasone implant (Ozurdex^®, Allergan S.A.), without response.

Discussion

Aminoglycoside toxicity is a rare, idiosyncratic, very serious complication for which there is no effective treatment.

Resumen

Caso clínico

Paciente que tras cirugía de glaucoma presenta pérdida súbita de visión, llegándose al diagnóstico de toxicidad retiniana por tobramicina, caracterizada por blanqueamiento retiniano con mancha rojo cereza, oedema macular, y vasculitis con evolución a atrofia papilar y macular con esclerosis arteriolar. Ante la gravedad del cuadro ensayamos con megadosis de corticoides e implante intravítreo de dexametasona (Ozurdex^®, Allergan S.A.) precozmente, sin buena respuesta.

Discusión

La toxicidad por aminoglucósidos es una complicación infrecuente, muy grave e idiosincrásica. Destacar que no existe tratamiento efectivo.