Intracameral cefuroxime safe, effective for endophthalmitis

Intracameral administration of cefuroxime is a safe and effective alternative to subconjunctival delivery of the drug for the treatment of endophthalmitis after cataract surgery, according to research presented by Patrick Yu-Wai-Man, MRCOphth.

Dr. Yu-Wai-Man, of the Sunderland Eye Infirmary, Sunderland, United Kingdom, discussed results of a retrospective study of all presumed infectious endophthalmitis cases presenting at the institution from Jan. 1, 2000 to Dec. 31, 2006. He said it was the first study comparing the two delivery methods of cefuroxime.

In the United Kingdom, he said, 68% to 83% of ophthalmologists use subconjunctival delivery of cefuroxime and are reluctant to administer the drug intracamerally because the rate of endophthalmitis seen is deemed acceptable.

Before Nov. 16, 2003, all patients undergoing cataract surgery at his institution were treated with a uniform antibiotic protocol that included 5% povidone iodine solution and subconjunctival cefuroxime injection at the end of surgery, he said. After that date, all patients were given cefuroxime intracamerally.

At the institution, intracameral delivery of cefuroxime led to a three-fold reduction in the rate of endophthalmitis compared with subconjunctival administration, Dr. Yu-Wai-Man said.

Specifically, the rate per thousand of presumed infectious endophthalmitis was 1.39 in the group treated subconjunctivally (27 cases in 19,425 cataract procedures performed) and 0.46 in the group treated intracamerally (eight of 17,318). No cases of anterior segment toxicity were seen.