Abstract
Two patients with presumed benzalkonium chloride (BAK) corneal toxicity after routine cataract surgery are presented. Patient 1 had corneal stroma and Descemet’s membrane folds. Patient 2 had moderate superficial punctate epithelial erosions (SPEE). They were on Chlorsig, Maxidex, and Acular eye drops tds postoperatively. The corneas of these two patients improved when BAK was removed or minimized from the postoperative eye drop regimen. Two vials of 1 ml dexamethasone 4mg/ml for injection were added to Chlorsig 10 ml bottle to substitute for Maxidex eye drops.
 BAK toxicity should be suspected when the cornea is not as clear as expected postoperatively. A practical way to eliminate BAK from postoperative eye drops is described, and would be useful until pharmaceuticals mass-produce BAK-free steroid eye drops economically.
Highlights
Two patients with presumed benzalkonium chloride (BAK) corneal toxicity after routine cataract surgery are presented
Two vials of 1 ml Dexamethasone 4mg/ml for injection were added to a Chlorsig 10 ml bottle, and Acular tds was replaced with Ilevro once daily
At 5 weeks, superficial punctate epithelial erosions (SPEE) improved and Visual acuity (VA) was 6/9 with myopic correction. When she underwent left cataract phacoemulsification and posterior chamber intraocular lens (PCIOL), she was on Chlorsig-Dexamethasone tds and Acular once daily
Summary
Two patients with presumed benzalkonium chloride (BAK) corneal toxicity after routine cataract surgery are presented. Patient 1 A 69-year-old male underwent routine left cataract phacoemulsification and posterior chamber intraocular lens (PCIOL) (Alcon SN60WF). At 1 week postoperative, (VA) was 6/18, with corneal stroma and Descemet’s membrane folds, minimal superficial punctate epithelial erosions (SPEE) fluorescein staining (Fig. 1 and Fig. 2), ECC of 2524/mm[2], and CCT of 665 microns. He was on a postoperative regimen of Chlorsig (chloramphenicol 0.5%, Aspen), Maxidex (dexamethasone 0.1%, Alcon), and Acular (ketorolac 0.5%, Allergan) drops tds.
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