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Study confirms intracameral antibiotic significantly reduces risk of postop endophthalmitis
J Cataract Refract Surg. 2010;36(2):203-207.
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Prophylactic intracameral cefuroxime markedly reduced acute-onset endophthalmitis after cataract surgery, according to a large study.
"We believe that our study is one of the first to directly compare the effectiveness of intracameral cefuroxime in the same population," the study authors said.
The prospective study included 13,652 patients who underwent cataract surgery between 1999 and 2008. One group comprised 6,595 patients treated between January 1999 and September 2005 who did not receive cefuroxime. A second group included 7,057 patients treated from October 2005 to December 2008 who received cefuroxime. The treatment protocol was changed in October 2005, when cefuroxime was approved for intraocular use.
Study data showed 42 cases of postoperative endophthalmitis reported between 1999 and 2008. The overall mean rate of presumed infectious endophthalmitis for the entire study period was 0.3%.
Results showed 39 cases of postoperative endophthalmitis in the first patient group and three cases in the second group. The infection rates were 0.59% and 0.043%, respectively. The first group had a statistically significantly higher incidence of postoperative endophthalmitis than the second group (P < .05).
Data also showed a mean Snellen final distance visual acuity of 20/60 in the affected eyes. Seven patients had final distance visual acuity worse than 20/200. Two cases of phthisis were reported.
Results were consistent with those of the European Society of Cataract and Refractive Surgeons endophthalmitis prophylaxis trial, which showed that patients not given intracameral cefuroxime had a five times greater risk of postoperative endophthalmitis than those who received the antibiotic, the authors said.
Ophthalmologists who want to incorporate a particular technique into their regimen for endophthalmitis prophylaxis based on evidence-based reduction in post-cataract surgery endophthalmitis find few published studies to guide them. Recently, a study by members of the European Society of Cataract and Refractive Surgeons found that use of intracameral cefuroxime reduced the incidence of endophthalmitis by 78% compared to no intracameral cefuroxime. The present study by Garcia-Saenz further supports the use of intracameral antibiotics by demonstrating a greater than 10-fold reduction in endophthalmitis in patients who received intracameral cefuroxime. This study is retrospective, non-controlled and involves patients having surgery using different techniques at different time periods. Despite noted flaws or shortcomings in this study, it has the potential to change the antibiotic prophylaxis for cataract surgery.
– Eric D. Donnenfeld, MD
OSN
Cornea/External Disease Board Member
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