Once more, and with compelling statistical significance (p < .00001), a research study has concluded that intracameral cefuroxime markedly reduces the incidence of endophthalmitis after cataract surgery.1 This systematic review of a decade of published studies also looked at the effectiveness of two other prophylactic antibiotic regimens.
- Topical antibiotics: There is no evidence they are effective for this use, the researchers concluded.
- Intracameral moxifloxacin: They found low-quality evidence that intracameral injection of moxifloxacin at the end of surgery might prevent 0 to 1 case of endophthalmitis per 1,000 cataract surgeries.
Danish public health initiative. Working on behalf of Denmark’s public health authority, the authors reviewed endophthalmitis studies published during a 10-year period ending in 2014. The researchers analyzed outcomes from randomized clinical trials of intracameral cefuroxime, as well as relevant nonrandomized studies of antibiotic use in cataract surgery.
Contrasting rates of endophthalmitis. The review bolstered the evidence supporting the use of intracameral cefuroxime. “Patients not receiving intracameral antibiotics have nearly six times the risk of endophthalmitis compared with patients who receive intracameral antibiotics,” said coauthor Line Kessel, MD, PhD, FEBO, an ophthalmologist and researcher at Copenhagen University Hospital Glostrup, in Glostrup, Denmark.
“In our study, we found that the rate of endophthalmitis was 1 out of 485 surgeries when intracameral antibiotics were not used, compared with 1 out of 2,855 when intracameral antibiotics were used.”
But the review contained little comfort for surgeons in the United States and other countries where, in the absence of a commercially available cefuroxime product, topicals remain widely used.
“There is no evidence that topical antibiotics protect against endophthalmitis, and yet this is the only antibiotic administration used by most surgeons. The rate of endophthalmitis in the USA is twice of that in Europe,” said Dr. Kessel.
A possible substitute. If cefuroxime is not an option, she recommended that surgeons use intracameral moxifloxacin instead of a topical antibiotic, even though evidence for the effectiveness of this substitution is limited.
“The difference between the effectiveness of moxifloxacin and cefuroxime appears to be much smaller than the difference between no intracameral antibiotics and cefuroxime,” Dr. Kessel said.
1 Kessel L et al. Acta Ophthalmol. 2015 March 16. [Epub ahead of print.]
Dr. Kessel reports no related financial interests.
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