Intracameral cefuroxime in the prevention of postoperative endophthalmitis: an experience from Hong Kong

Ng, Alex Lap-Ki; Tang, Wilson W.T; Li, Patrick Siu-Hung; Li, Kenneth Kai-Wang

doi:10.1007/s00417-016-3473-0

Cited by 21 publications

(11 citation statements)

References 32 publications

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“…[71123] ICC injection during cataract surgery was well tolerated in a prospective study of forty penicillin-allergic patients with a negative preoperative cefuroxime skin test. [24] The use of ICC in patients with penicillin allergy was explored between 2004 and 2012 in a case–control registry study; the control group was the cohort of patients undergoing cataract surgery under a hospital policy of excluding patients with self-reported penicillin allergy.…”

Section: Resultsmentioning

confidence: 99%

Risks of cefuroxime prophylaxis for postcataract endophthalmitis

Alabduljabbar

Stone

2017

Middle East Afr J Ophthalmol

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Section: Resultsmentioning

confidence: 99%

Risks of cefuroxime prophylaxis for postcataract endophthalmitis

Alabduljabbar

Stone

2017

Middle East Afr J Ophthalmol

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“…Retrospective studies from Canada, France, South Africa, and Sweden, among other countries, have found significant decreases in the rate of POE with the use of intracameral cefuroxime. In Spain, reductions in endophthalmitis were as high as tenfold with intracameral cefazolin, another cephalosporin [ 40 – 46 ] A tertiary center in Hong Kong reduced the incidence of endophthalmitis to 0% with the use of intracameral cefuroxime that had been compounded by the hospital pharmacy [ 47 ].…”

Section: Intra-operative Carementioning

confidence: 99%

The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery: How Good is the Evidence?

George

Stewart

2018

Ophthalmol Ther

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Post-operative endophthalmitis (POE) following cataract surgery is an uncommon, vision-threatening complication that has been reported to occur at rates of between approximately 0.03% and 0.2%. Prompt diagnosis and treatment of endophthalmitis is critical for minimizing vision loss, but most recent efforts have focused on the prophylactic administration of antibiotics to prevent the development of endophthalmitis. Surgeons from around the world have different topical and intracameral antibiotic usage patterns to prevent endophthalmitis, and to date no general consensus regarding best practice has emerged. Several studies have reported on the routine use of intracameral cefuroxime, moxifloxacin, and vancomycin, including a single randomized clinical trial by the European Society of Cataract and Refractive Surgery (ESCRS) in 2007. These studies have notable shortcomings, but many authors suggest that intracameral cefuroxime together with topical antibiotics probably decreases the risk of endophthalmitis. However, the deleterious effects of routine prophylactic antibiotics, which include toxicity, cost, and increasing antimicrobial resistance, among others, are noteworthy. In contrast, aseptic technique with pre-operative instillation of povidone-iodine remains the only technique supported by level I evidence to reduce the incidence of endophthalmitis. Although the routine use of intracameral antibiotics continues to increase throughout the world, data from multicenter, randomized, prospective trials is needed to provide better guidance regarding the prophylactic use of antibiotics.

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“…Multiple studies comparing rates of endophthalmitis from time periods before and after IC cefuroxime implementation have shown significantly reduced rates since its introduction. 48,49 A shortcoming of retrospective studies is the failure to account for improvements in surgical and aseptic technique that occurred over the same time periods. 44 Recently, both moxifloxacin and cefuroxime have demonstrated efficacy at reducing endophthalmitis after phacoemulsification compared to controls.…”

Section: Prophylaxismentioning

confidence: 99%

Infectious Endophthalmitis: Trends in Microbiology, Management, and Surgical Techniques

Keffer

Chin

Almeida³

2018

Journal of VitreoRetinal Diseases

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The purpose of this review is to provide an update on etiologies, preventive practices, management options, and surgical techniques for infectious endophthalmitis. Methods: A literature search was conducted for studies published over the past 5 years. Results: Endophthalmitis continues to be an uncommon but dangerous complication following cataract surgery. Recently, intravitreal injections have become heavily utilized as a treatment for various ocular diseases, leading to a greater incidence of postinjection infections. Likewise, long-term risk of endophthalmitis should always be a consideration following glaucoma surgery and implanted drainage devices. Although significant overlap exists for causative organisms among the different etiologies, more targeted studies are needed to better optimize treatment. There has been a lack of updates to treatment guidelines since the Endophthalmitis Vitrectomy Study was published in 1995. Despite promising outcomes seen with newer surgical techniques, the lack of randomized clinical trials represents a major barrier to widespread implementation of these approaches. Conclusions: Povidone-iodine prophylaxis remains the primary evidence-based technique for decreasing the rates of endophthalmitis following intraocular procedures. Intracameral antibiotics have gained momentum in recent years and represent a step forward in mitigating the risk of infection with cataract surgery, although some debate still exists. Newer surgical techniques for vitrectomy that improve visualization, minimize surgical trauma, and decrease operative time would benefit from large-scale randomized trials.

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Intracameral cefuroxime in the prevention of postoperative endophthalmitis: an experience from Hong Kong

Abstract: The use of intracameral cefuroxime could significantly reduce the rate of postoperative endophthalmitis in a tertiary centre in Hong Kong. The use of aseptic compounding to prepare cefuroxime aliquots by hospital pharmacy appeared to be safe and efficacious.

Cited by 21 publications

References 32 publications

Risks of cefuroxime prophylaxis for postcataract endophthalmitis

Risks of cefuroxime prophylaxis for postcataract endophthalmitis

The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery: How Good is the Evidence?

Infectious Endophthalmitis: Trends in Microbiology, Management, and Surgical Techniques

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