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Vincent Daien, Laurence PAPINAUD, Mark C Gillies, Caroline DOMERG, Nicolas NAGOT, Sandy LACOMBE, Jean Pierre DAURES, Isabelle CARRIERE, Max Villain; Impact and safety of cefuroxime for post-operative endophthalmitis after cataract surgery: a national population study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1990.
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© 2017 Association for Research in Vision and Ophthalmology.
Post-operative endophthalmitis (POE) is the most severe complication of the cataract surgery. Clinical trials have reported that intraocular cefuroxime administered at the conclusion of cataract surgery significantly lowered the risk of endophthalmitis. However, some surgeons still do not use this prophylactic antibiotic treatment in light of case reports of macular edema. The purpose of this study was to assess the impact and safety of cefuroxime for POE.
This is an observational, real-world, national population study, including all patients aged over 40 years who underwent primary cataract surgery in the 1,546 French healthcare facilities, public or private, from January 2010 to October 2014.
From January 2010 to October 2014, 3,351,401 eyes of 2,434,008 patients ≥ 40 years old (58.9% women, mean age 73.9 ±9.5 years) underwent cataract surgery; 1,941 (0.08%) patients developed POE during the 6 weeks after cataract surgery. The incidence of POE after cataract surgery decreased over the course of the study: 0.11%, 0.09%, 0.08%, 0.06% and 0.05% in 2010, 2011, 2012, 2013 and 2014, respectively (p trend=0.001) as the use of cefuroxime prophylactic injection increased: 11.1%, 14.4%, 32.8%, 64.8% and 79.1% in 2010, 2011, 2012, 2013 and 2014, respectively (p trend=0.001). After multivariate adjustment, the risk of POE was reduced with the use of cefuroxime (OR 0.61; 95% CI 0.56 to 0.68). The retinal safety of cefuroxime, which was assessed by multi-adjusted odds of retinal cystoid macular edema, was not increased for patients receiving cefuroxime injections (OR 0.86; 95% CI 0.71 to 1.05).In patients with perioperative capsular rupture of the lens (the major risk factor for POE which occurred in 0.14% of surgeries) and cefuroxime injection, POE incidence was lower than without cefuroxime (0.37% versus 0.51%, respectively, p=0.001), while the risk of cystoid macular edema was not significantly increased (5.6% with versus 7.3% without, respectively, p=0.12).
We found consistent evidence that intracameral cefuroxime administered at the conclusion of cataract surgery significantly lowers the risk of endophthalmitis and is safe in patients with or without perioperative capsular rupture in routine practice. This antibioprophylaxis should be considered for routine use to prevent POE, the most severe complication of cataract surgery.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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