Toxic endothelial cell destruction from intraocular benzalkonium chloride

Purpose: To present a cluster of cases of corneal edema occurring after pha coemulsification. Setting: Regional hospital in rural Australia. Methods: This retrospective case series comprised 12 patients from a single surgical list comprising 19 cases who developed persistent corneal edema a fter having phacoemulsification. Results: After 6 months, the edema improved in I patient. Inadvertent intra ocular use of balanced salt solution (BSS (R)) preserved with benzalkonium chloride was found to be the cause of this serious complication. Conclusions: Benzalkonium chloride in concentrations commonly used extraocu larly is highly toxic to the corneal endothelium. Every possible safeguard should be taken to prevent inadvertent intraocular use of such preserved so lutions. (C) 2001 ASCRS and ESCRS.