Supplemental cefuroxime doesn’t reduce endophthalmitis, but still recommended

This large prospective study found no strong evidence to support the use of supplemental intracameral cefuroxime to reduce endophthalmitis after cataract surgery, but the marginal benefit they did find might justify its use.  

None of the 15,000 patients studied received prophylactic preoperative antibiotic drops. All were prepped with povidone–iodine 5.0%. About half received an intracameral injection of cefuroxime at the end of surgery. Postoperatively, all patients received ofloxacin 0.3% 4 times daily for 1 week and topical prednisolone acetate 1.0% 4 times daily for 1 week, tapered thereafter.

The incidence of postop endophthalmitis was lower in the cefuroxime group, but not significantly (P = .57). This finding is in contrast to 3 published European studies that confirmed the efficacy of intracameral cefuroxime.

The randomized, multicenter ESCRS study found it decreased the endophthalmitis risk by 5 times. Later, a Spanish study found that it decreased the risk from 0.59% to 0.043% (relative risk, 0.072;P ≤ .05). A French study also concluded in favor of cefuroxime prophylaxis.

The authors speculate that this difference between the outcomes at their eye care center in India and that of the 3 European studies may be due to the lower rate of preexisting endophthalmitis in their study population.

While intracameral cefuroxime has become the standard of care in European countries, it is not fully recognized in other countries. After reevaluating its use in India, the authors believe it’s reasonable to continue using cefuroxime because it’s inexpensive, provides good coverage of gram-positive organisms and reduces relative risk.