Cefuroxime irrigation to combat endophthalmitis

Chinese researchers have shown that adding the antibiotic cefuroxime to the irrigating solution used during cataract surgery reduces the risk of postoperative endophthalmitis.

The nine-year investigation by the Shandong Eye Institute, First Medical University and Academy of Medical Sciences in Qingdao, included 61,299 eyes. A control group of 15,948 eyes were operated on using balanced salt solution (BSS) as the irrigating solution, while 45,351 eyes underwent surgery using a BSS and cefuroxime (1,500µg/mL) solution. Endophthalmitis occurred in 11 eyes (0.07%) among the BSS-only group and in five eyes (0.01%) among those irrigated with cefuroxime solution.

Dr Yusen Huang of the Shandong Eye Institute pointed out that although intracameral antibiotics are already commonly used as endophthalmitis prophylaxis during cataract surgery, the optimal choice of prophylactic routes and antibiotics is disputed. “In European countries, commercial cefuroxime formulation (Aprokam) has been widely used, and the dose administered is the same as in the European Society of Cataract and Refractive Surgeons’ (ESCRS’) randomised prospective study, demonstrating its efficacy.”

Although the intracameral concentration in this study was about 45% of ESCRS’ recommendation, it still reduced the rate of post-cataract surgery endophthalmitis sevenfold, said Dr Huang, while cautioning that this method is not suitable for patients with a history of vitrectomy, considering the potential for rapid posterior segment diffusion of the antibiotic and thus potential macular toxicity.

The full study was published in Infection and Drug Resistance.