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Andrew Melchioris, Michael Zgrabik, Joan Hornik, David G Miller; Ocular Complications Following Intracameral Injection of an Elevated Dose of Cefuroxime During Phacoemulsification Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5589.
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© ARVO (1962-2015); The Authors (2016-present)
Intracameral injection of cefuroxime sodium (1 mg/0.1 mL) has been reported to reduce the risk of endophthalmitis following cataract surgery and is becoming more common. This is a compounded medication, which can lead to rare dilution errors. This study describes the results of 10 times elevated doses of intracameral injection of cefuroxime sodium. Dilution errors of this type may be more common with the adoption of cefuroxime endophthalmitis prophylaxis.
We retrospectively analyzed 7 eyes of 7 patients who were operated on the same day by the same surgeon. At the end of surgery, an incorrect dose of 10 mg in 0.1 mL cefuroxime (30 mg/mL, GlaxoSmithKline) was injected into the anterior chambers of 7 eyes. Incorrect dilution of cefuroxime was noticed at the end of operation day. The patients were seen at 1 day, 1 week, and 1 month follow-ups by the same physician, and the best corrected visual acuity, macula, and intraocular inflammation of each patient were closely observed. Visual acuities were converted to logMar. Comorbidities were also tabulated.
The preoperative mean visual acuity was logMar 0.77 (20/120). On postoperative day 1, the mean visual acuity in logMar was 1.40 (20/500 snellen) showing a loss of 0.63 units. On the postoperative day 1, 6/7 patients (86%) were diagnosed with cystoid macular edema, and 3/7 patients (43%) were found to have excessive (2+) cell/ flare. At one week, the mean logMar was 0.54 (20/70), and macular edema and excessive inflammation resolved in all cases. Final visual acuity mean at 1 month was 0.44 logMar (20/55), a 0.96 logMar improvement from postoperative day 1 visual acuity, and a 0.33 improvement from preoperative visual acuity. Preexisting ocular comorbidities (5 with age related macular degeneration, 1 with diabetes mellitus, 2 with epiretinal membrane, and 1 with primary open angle glaucoma) were present in 5/7 patients (71%), and remained stable.
Compounded intracameral injection of cefuroxime sodium at a dose of 10 mg/0.1 mL (10 times normal) was associated with diminished acuity, cystoid macular edema, and excessive intraocular inflammation resolving largely within 1 week in this study. Elevated doses of cefuroxime, occurring from dilution errors in compounding this medication, appear to lead to ocular morbidities, which are self limiting.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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