Expanded analysis confirms intracameral antibiotic for reducing endophthalmitis

TAKE HOME MESSAGE: An updated analysis from cataract surgeons at Kaiser Permanente Northern California again shows the benefit of intracameral antibiotic use for reducing the rate of postoperative endophthalmitis.

 

By Cheryl Guttman Krader; Reviewed by Neal H. Shorstein, MD

Walnut Creek, CA-An updated analysis based on an expanded patient cohort corroborates the benefit of intracameral antibiotic use.

“We can conclude that intracameral antibiotic injections are effective in reducing endophthalmitis risk,” said Neal H. Shorstein, MD, ophthalmologist and associate chief of quality, Kaiser Permanente, Walnut Creek, CA, and lead author of the original study.

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“However, due to the low incidence of this infection and because of the effectiveness of intracameral treatment, no definite conclusion can be drawn to differentiate between cefuroxime and moxifloxacin,” Dr. Shorstein said “Given the very high concentration of agent in the anterior chamber achieved with intracameral injection, there may be little difference between them.”

In 2013, ophthalmologists from Kaiser Permanente Northern California published the first United States study demonstrating the efficacy of intracameral antibiotic injection for reducing the rate of postoperative endophthalmitis [J Cataract Refract Surg. 2013;39:8-14].

The study analyzed data from 16,264 eyes operated on between 2007 and 2011, including 12, 609 that received intracameral injection primarily with cefuroxime (84%), and found adoption of intracameral antibiotic use was associated with a 22-fold decline in the rate of clinical endophthalmitis.

The updated analysis included data for 129,077 procedures performed by 99 community-based surgeons in 20 surgical centers over the years 2005 to 2012.

Use of intracameral antibiotic for endophthalmitis prophylaxis began in late 2007 with injection of cefuroxime 1 to 2 mg into the anterior chamber. The intracameral technique was increasingly adopted over time, and at many centers, moxifloxacin 100 mcg was the preferred antibiotic.

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