Suspected Cefuroxime-Induced Cystoid Macular Edema Following Non-Toric Implantable Collamer Lens Implantation: A Case Report

Purpose: We present a rare case of suspected cefuroxime-induced cystoid macular edema (CME) subsequent to non-toric implantable collamer lens (ICL) surgery. Case Presentation: A 23-year-old lady with high myopia underwent refractive ICL implantation in both eyes. On the first day, the right eye was performed ICL implantation first, and postoperative uncorrected distance visual acuity (UDVA) was improved to 20/20. On the following day, the left eye underwent ICL implantation. Surprisingly, postoperative UDVA dropped to 20/63 with no improvement upon correction. At the end of each surgery, 0.1 mL of cefuroxime (1.5 mg/0.1 mL) will be injected into the anterior chamber. Scanning laser ophthalmoscopy (SLO) revealed macular edema in the left eye, followed by optical coherence tomography (OCT) confirming CME and serous retinal detachment. With the treatment of pranoprofen and prednisone, the CME decreased significantly and UDVA was increasing on the fifth postoperative day. At six-month follow up, the CME had completely subsided and UDVA reached to 20/20. Conclusion: Acute CME after ICL implantation, anatomically and temporally aligned with intracameral cefuroxime injection and lacking other inflammatory or vascular triggers, strongly points to intracameral cefuroxime ocular toxic syndrome (ICOTS). Ophthalmologists should be aware that suboptimal visual recovery after ICL surgery may indicate CME and must attend to the dose safety of intracameral cefuroxime.