ESCRS Endophthalmitis Study: Perioperative antibiotics prevent endophthalmitis

June 28, 2008

Prophylactic intracameral cefuroxime injections prevent development of endophthalmitis after cataract surgery, according to Peter Barry, MD, FRCS, from Royal Victoria Eye and Ear Hospital, Dublin, Ireland. He reported the results of the European Society of Cataract and Refractive Surgeons Endophthalmitis Study.

Prophylactic intracameral cefuroxime injections prevent development of endophthalmitis after cataract surgery, according toPeter Barry, FRCS, from Royal Victoria Eye and Ear Hospital, Dublin, Ireland. He reported the results of the EuropeanSociety of Cataract and Refractive Surgeons Endophthalmitis Study.

This conclusion was reached after a study in which about 16,000 patients were randomly assigned to one of four treatmentgroups: 1) placebo drops and no injection, 2) placebo drops and intracameral cefuroxime (1 mg), 3) topical levofloxacin 0.5%and no injection, or 4) topical levofloxacin 0.5% and intracameral cefuroxime (1 mg), Dr. Barry said.

The results indicated that in the group that received placebo drops and no injection, the endophthalmitis rate was 33 per10,000 (0.33%) for presumed endophthalmitis and 23 per 10,000 (0.23%) for proven endophthalmitis.

"When compared with the groups that received intracameral cefuroxime, the rates were six per 10,000 for presumedendophthalmitis and four per 10,000 for proven endophthalmitis, demonstrating that the use of the intracameral antibioticreduced the rate of endophthalmitis by a rate exceeding a factor of five," Dr. Barry said.

The true rates of endophthalmitis in this study ranged from 0.05% in the groups that received intracameral cefuroxime to0.35% in the groups that did not receive an antibiotic. Staphylococcus and streptococcus infections wereidentified as the primary causes of endophthalmitis, according to Dr. Barry.

While cefuroxime is an old drug that does not cover all organisms, its efficacy has been proven in a large number of patientsin the study under discussion and in a Swedish study of 425,000 patients.

In addition, "the emerging resistance to the fourth-generation fluoroquinolones would argue against the role of these drugsin preventing endophthalmitis in cataract patients in the future," Dr. Barry said. "Use of intracameral moxifloxacin andgatifloxacin is probably too late based on the reports of emerging resistance."