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ESCRS Endophthalmitis Study results highlighted at annual meeting in London
LONDON — Final results of a multicenter European study confirm that intracameral antibiotics can play a role in preventing endophthalmitis after cataract surgery, according to Peter James Barry, MD, the chairman of the study.
Dr. Barry described the results of the European Society of Cataract and Refractive Surgeons Endophthalmitis Study in delivering the 2006 Ridley Medal Lecture at the ESCRS meeting here.
“Cefuroxime injection lowers the chances of bacterial contamination by a factor of five. This means that the risk rate is reduced to less than five in 10,000 cases,” he said.
Cefuroxime seems to be particularly protective against streptococci, which can cause severe blinding infections, Dr. Barry said. No cases of streptococcal infection were seen in patients who received cefuroxime, he said.
Cefuroxime is not approved for intraocular use, Dr. Barry noted. For the study, investigators were required to obtain special exemptions for its use. Most countries allow physicians to use cefuroxime off-license, although physicians are responsible for the ramifications, he said.
“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 a 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 a 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.