Systematic review of retinal toxicity after injection of cefuroxime during cataract surgery

This review is to elucidate the retinal toxicity following intraocular injections of cefuroxime, including possible risk factors, clinical manifestations, visual prognosis and treatment. Refereed publications were retrieved from PubMed, the Cochrane Library, and EMBASE databases, using the search terms cefuroxime, retina, macular edema, serous retinal detachment, toxic, cataract surgery. The screening was not limited by publication date, country or study type. We screened out 51 articles out of which 32 met the inclusion criteria for this systematic review. Data regarding sample size calculation reporting and trial characteristics were extracted for each trial. Retinal toxicity can be caused by both high and standard doses of cefuroxime injections in different ethnic groups, with risk factors including overdose, blood-retinal barrier disruption, anterior and posterior chamber connection. The typical clinical manifestations of retinal toxicity are cystoid macular edema and extensive serous retinal detachment, mainly involving the outer nuclear and outer plexiform layers, with a good prognosis for visual acuity in most cases, but in a small number of cases, the prognosis is not satisfactory. In conclusion, though the current use of intracameral injection antibiotics in cataract surgery is gradually increasing, the potential risks should not be ignored. Unexplained poor vision on the first day after cataract surgery can be supplemented with macular optical coherence tomography to rule out cefuroxime-related retinal toxicity.