Using intracameral cefuroxime as a prophylaxis for endophthalmitis.

Community EyE HEaltH Journal | Vol 21 iSSuE 65 | marCH 2008 This paper presents the results of a large and well-designed randomised trial, which examined the effectiveness of an injection of cefuroxime 1 mg in the anterior chamber at the conclusion of cataract surgery. The results showed such a great benefit from the use of cefuroxime that the trial was stopped early, because it was considered unethical not to use the treatment. From these figures, out of 10,000 cataract operations without postoperative intracameral cefuroxime, 23.3 would be expected to develop culture-positive endophthalmitis. With intracameral cefuroxime, this number would only be 4.4 (OR=5.32, 95%; CI 1.55–18.26). Globally, 10 million cataract operations are performed every year. This gives an incidence of endophthalmitis of 23,000 per year. If all surgeons used intracameral cefuroxime in every case, the incidence of endophthalmitis would be reduced to 4,400. What about toxicity? It appears that the intracameral injection of cefuroxime is not toxic: Swedish researchers have published results on many thousands of eyes that have received intracameral cefuroxime without any adverse effects.1 It is possible that these results on the prophylactic effect of intracameral cefuroxime might be different in developing countries. This study was carried out in Europe, and it was also carried out on eyes that were having phacoemulsification. It is likely that the majority of these eyes had clear corneal incisions, with no sutures. Few clinics in developing countries routinely use phacoemulsification.They tend to favour extracapsular extraction, a technique in which the wound is covered with a conjunctival flap and which may be associated with a lower risk of infection. However, since the type of wound closure is not the only factor in the occurrance of endophthalmitis, similar prophylactic results may be obtained with the intracameral injection of cefuroxime at the end of extracapsular cataract extraction. Despite these uncertainties, this study represents the best evidence we have regarding the prevention of this devastating complication.