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J. Shahar, E. Zemel, G. Heilweil, I. Perlman, A. Loewenstein; Cefuroxime- Is It Safe Enough to Be Used on a Large Scale Basis in Cataract Surgery?. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6241.
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Intracameral Cefuroxime (a second generation cephalosporin) prophylaxis was recently found to significantly lower the risk of endophthalmitis following cataract surgery, and is now the common practice used for post operative endophthalmitis prevention. Our aim was to evaluate retinal toxicity of Cefuroxime in a rabbit model.
Two groups of albino rabbits were used. A low dose group (1mg/0.1ml, the clinically used dose, n=9) and a high dose group (10mg/0.1ml, n=20). The Right eye of each rabbit was injected with 0.1 ml Cefuroxime solution (Experimental eye) and the left eye was injected with 0.1 ml saline (control eye). Electroretinogram (ERG) and Visual Evoked Potential (VEP) were recorded at 3 hr, 4 days, 1, 2 and 4 weeks. Histological preparations and GFAP immunostaining were made throughout the follow-up period.
No functional (ERG and VEP) or morphological damage was found in the low dose group, but GFAP, a marker for retinal damage, was over-experssed in the experimental compared to the control retinas. In the high dose group, we found a significant decrease in the ERG responses of the experimental eyes as early as 3 hr after injection, followed by partial recovery during 4-weeks of follow-up. The VEP did not differ significantly between the two eyes. Morphology of retinas from the experimental eyes was markedly changed, mainly involving the outer segments of the photoreceptors, localized in the region of injection. GFAP expression was markedly elevated in Muller cells of the experimental eyes and not in the control eyes.
Cefuroxime is toxic to the rabbit retina when it is injected intravitreally at a dose 10 times higher than the clinically used dose. The toxicity pattern showed a transient reduction in the ERG responses that was followed by gradual partial recovery. A dose of 1mg/0.1ml of Cefuroxime, the clinically used dose, did not cause measurable toxic effects to the rabbit retina. These data indicate that caution should be exercised when Cefuroxime is used in ophthalmic surgery.
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