Abstract
Purpose :
Intracameral cefuroxime is standard practice following cataract surgery to prevent infection. The standard dose is 1.0 mg/0.1 ml. Both dilution errors during reconstitution and inaccurate volume administration can cause inadvertent effects from subtherapeutic and toxic doses. Complications include corneal oedema, temporarily raised intraocular pressure, intraocular lens dislocation and permanent loss of vision. We measured the volume of intracameral cefuroxime injected post-cataract surgery to assess the true amount given.
Methods :
26 patients having cataract surgery under 2 different surgeons were observed at Moorfields Eye Unit, Bedford Hospital. All patients received cefuroxime injections which were administered via a diabetic 1ml syringe. The volume pre- and post-injection was recorded and patients were routinely followed up to assess for complications.
Results :
Mean±SD of the pre- and post-injection volumes was 0.36±0.11 ml and 0.24±0.11 ml. The average volume injected was 0.12±0.02 ml. In 3 cases there was accidental loss of cefuroxime prior to injection which required repriming the syringe and led to over dosage. In a further 3 cases, there was initial under dosing which was only corrected following inspection of the syringe post-injection. All surgery was routine without any complications.
Conclusions :
Our data showed that on average 20% more than the standard dose was administered; although still below the toxic range, complications from toxicity are important and should not be disregarded. Even a standard dose has been reported to cause retinal toxicity. Subtherapeutic doses were avoided in 3 patients which could have predisposed them to infection.
The current preparation and administration process is suboptimal. Syringes that are preloaded with more than 0.1ml to account for accidental losses risk over dosage whilst preloading with exactly 0.1ml overlooks the problem of observed and unobserved accidental losses prior to injection, especially on difficult paracentesis entry.
As injection is performed without direct visualisation of the syringe, we recommend checking the syringe post-injection to ensure correct dosage. Ideally, a syringe should be designed to address both under and over injection. A graduated pre-made syringe providing the surgeon with tactile feedback could have a role. Its applications could extend to other ophthalmic treatments such as mydrane injections.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.