Comparative analysis of the safety and efficacy of intracameral cefuroxime, moxifloxacin and vancomycin at the end of cataract surgery: a meta-analysis

Bowen, Randy C.; Zhou, Andrew Xingyu; Bondalapati, Sailaja; Lawyer, Thomas W.; Snow, Karisa B.; Evans, Patrick; Bardsley, Tyler; McFarland, Mary; Kliethermes, Matthew; Shi, Dallas; Mamalis, Christina; Greene, Tom; Rudnisky, Christopher J.; Ambati, Balamurali K.

doi:10.1136/bjophthalmol-2017-311051

Cited by 86 publications

(88 citation statements)

References 76 publications

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“…Another large retrospective study examined more than 57 000 eyes found 8.78‐fold risk reduction attributed to using vancomycin in the irrigation solution, similar to our practice . A meta‐analysis evaluating vancomycin efficacy including 154 669 eyes in which vancomycin bolus dose was most commonly used, found an odds ratio of 0.09 in favour of using intracameral vancomycin . Intracameral vancomycin had the lowest rate of endophthalmitis 0.0106%, compared with moxifloxacin 0.0153% and cefuroxime 0.0332% …”

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwesupporting

confidence: 68%

“…Alternative intracameral antibiotics commonly used for endophthalmitis prophylaxis are cefuroxime and moxifloxacin. Cefuroxime is the only antibiotic found to be effective in a randomized controlled study, with further evidence of efficacy in a recently published meta‐analysis . This study also found more complications reported with intracameral cefuroxime compared with vancomycin and moxifloxacin.…”

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwesupporting

confidence: 53%

“…This study showed 3.5‐fold (0.07% to 0.02%) endophthalmitis rate reduction . In a recent meta‐analysis (600 955 eyes) 4.2‐fold (0.0642% to 0.0153%) endophthalmitis rate reduction was demonstrated using intracameral moxifloxacin …”

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwesupporting

confidence: 52%

“…Other large retrospective studies demonstrated the efficacy of other antibiotics like moxifloxacin and vancomycin . A recent meta‐analysis of more than 900 000 eyes looked at the efficacy of intracameral cefuroxime, moxifloxacin and vancomycin and found a 5‐fold postoperative endophthalmitis rate reduction by using intracameral antibiotics for prophylaxis …”

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwementioning

confidence: 99%

“…A meta‐analysis evaluating vancomycin efficacy including 154 669 eyes in which vancomycin bolus dose was most commonly used, found an odds ratio of 0.09 in favour of using intracameral vancomycin . Intracameral vancomycin had the lowest rate of endophthalmitis 0.0106%, compared with moxifloxacin 0.0153% and cefuroxime 0.0332% …”

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwementioning

confidence: 99%

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Intracameral antibiotics for prophylaxis of postoperative endophthalmitis in Australia: a review

Lipsky

Barrett

2018

Clinical Exper Ophthalmology

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Postoperative endophthalmitis is a severe complication which may result in loss of vision. Intracameral antibiotics have been shown to reduce the risk of this complication and are extensively used worldwide, with vancomycin, cefuroxime and moxifloxacin most commonly used. Choices in Australia are currently limited to vancomycin and cefazolin, since cefuroxime and moxifloxacin are not available. Vancomycin has been safely and effectively used in our department for more than two decades. Recent publications have risen concerns regarding the association of haemorrhagic occlusive retinal vasculitis a potentially blinding complication with intracameral vancomycin. This concern has driven us to review the safety and efficacy of currently available antibiotics in the context of Australian practice.

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Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwesupporting

confidence: 68%

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwesupporting

confidence: 53%

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwesupporting

confidence: 52%

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwementioning

confidence: 99%

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwementioning

confidence: 99%

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Intracameral antibiotics for prophylaxis of postoperative endophthalmitis in Australia: a review

Lipsky

Barrett

2018

Clinical Exper Ophthalmology

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Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery

van Rooij,

Nolte,

van de Vondervoort

et al. 2024

JAMA Ophthalmol

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ImportanceAlthough the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics.ObjectiveTo compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine.Design, Setting, and ParticipantThis was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included.ExposurePovidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears.Main Outcome and MeasurePostoperative endophthalmitis incidence.ResultsPostoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000).Conclusions and RelevanceNo difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.

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Intracameral Antibiotics After Cataract Surgery—In Which Cases?

Daien,

Villain,

Chamard

2024

JAMA Ophthalmol

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Comparative analysis of the safety and efficacy of intracameral cefuroxime, moxifloxacin and vancomycin at the end of cataract surgery: a meta-analysis

Abstract: Intracameral cefuroxime and moxifloxacin reduced endophthalmitis rates compared with controls with minimal or no toxicity events at standard doses. Additionally, intracameral antibiotics alone may be as effective as intracameral plus topical antibiotics.

Cited by 86 publications

References 76 publications

Intracameral antibiotics for prophylaxis of postoperative endophthalmitis in Australia: a review

Intracameral antibiotics for prophylaxis of postoperative endophthalmitis in Australia: a review

Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery

Intracameral Antibiotics After Cataract Surgery—In Which Cases?

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