Endophthalmitis Tx After Cataract Surgery

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A study from the Netherlands supports the efficacy of intravitreal vancomycin and ceftazidime to treat acute endophthalmitis after cataract surgery.¹ “The findings strengthen the fact that current anti­biotic treatment for endophthalmitis after cataract surgery is still effective, despite the slight change in cultured strains, specifically more gram-negative ones, compared to previous years,” said Niels Crama, MD, at Radboud University Medical Center in Nijmegen.

Dr. Crama warned, however, that the increased use of intracameral antibiotics at the end of surgery “may create a false sense of safety.” He also emphasized that surgical technique continues to play a critical role in endophthalmitis prophylaxis.

Retrospective series. For this study, researchers reviewed clinical and microbiology data of 126 patients who were referred to a tertiary center between 2007 and 2015 for acute endophthalmitis following unilateral cataract surgery.

Bacterial culprits. Bacterial growth occurred in 73% of cases. Coagulase-negative staphylococci was the most common strain (53.3%), followed by other gram-positive (31.5%) and gram-negative (14.1%) strains. Vancomycin was effective in nearly all (98.7%) gram-positive strains, while ceftazidime proved 100% effective against gram-negative strains.

Outcomes. Two-thirds (67.5%) of the patients recov­ered to a visual acuity of 20/40 or better, while 15% had vision of hand motions to 20/50, and 17% had light per­ception or worse. The virulence of the causative bacteria was the main predictor of a poor visual outcome, which suggests that earlier treatment might have an impact on outcome.

Surgical factors still matter. A subgroup of patients (n = 25) developed endophthalmitis despite intra­cameral cefuroxime after surgery, highlighting the ongoing importance of surgical factors—particularly careful wound construction and closure—in preventing postoperative endophthalmitis. (In the Netherlands, intracameral cefuroxime is recommended in high-risk cases, although a growing number of clinics currently administer antibiotic prophylaxis after every cataract surgery.)

Complications during surgery occurred in 11 (44%) of those cases, including seven cases of capsular rupture. “We found in the literature that intracameral cefuroxime is only effective for the first few hours after injection in an intact anterior chamber,” Dr. Crama said. “This is even shorter for complicated surgery with leak­ing wounds.”

—Miriam Karmel

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1 de Geus SJR et al. Ophthalmol Retina. 2021;5(6):503-510.

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Relevant financial disclosures—Dr. Crama: None.

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