ESCRS Endophthalmitis Study confirms cefuroxime's role in reducing infection risk

LONDON — Final results of the ESCRS Endophthalmitis Study confirm the role of intracameral cefuroxime in preventing intraocular infection, according to Peter Barry, MD, Study Chairman and 2006 Ridley Medal Lecturer. He presented the findings here at the European Society of Cataract and Refractive Surgeons annual meeting.

"Cefuroxime injection lowers the chances of bacterial contamination by a factor of 5. This means that the risk rate is reduced to less than 5 in 10,000 cases," Dr. Barry said.

Cefuroxime seems to be particularly protective against streptococci, which cause extremely severe infections often leading to blindness. In the study, no cases of streptococcal infection were found in groups of patients who received cefuroxime, he said.

Cefuroxime is not licensed for intraocular use, Dr. Barry noted. For the study, investigators were required to obtain a special exemption certificate, which expired once patient recruitment ended. Most countries do allow physicians to use cefuroxime off-license, although physicians are responsible for the ramifications, he said.

Peter Barry

"In practical terms, taking 750 mg of cefuroxime powder and diluting it by yourself to a concentration of 1 mg [per] 0.1 mL exposes you to all of the risks of kitchen pharmacy, with errors in dilution, a possible induction of toxic anterior segment syndromes and the frightening possibility of contamination, for example with Pseudomonas, against which cefuroxime is not effective," Dr. Barry said.

Because of this, Dr. Barry appealed to the pharmaceutical industry to provide ophthalmologists with single sterile unit doses of cefuroxime for use in the millions of cataract procedures performed annually worldwide.

In addition to the beneficial role of cefuroxime, the study established the crucial contribution of polymerase chain reaction in proving infection in suspected cases. It also established the incidence of endophthalmitis risk factors other than non-use of cefuroxime injection. In particular, silicone IOLs as opposed to acrylic lenses, as well as the use of clear corneal incisions rather than scleral tunnel incisions, were found to significantly increase the likelihood of experiencing such infections.

The ESCRS Endophthalmitis Study involved nearly 16,000 patients examined in 24 centers in nine European countries, making it "the largest study of an antibiotic in the history of medicine," Dr. Barry said.

Results of such a large study are highly reliable and should convince cataract surgeons to incorporate the use intracameral cefuroxime into their standard operating procedure, he noted.