title: Reevaluating intracameral cefuroxime as a prophylaxis against endophthalmitis after cataract surgery in India.
abstract: OBJECTIVE
  To determine whether an intracameral injection of cefuroxime sodium at the conclusion of cataract surgery lowers the incidence of acute-onset postoperative endophthalmitis.
  
  
  METHODS
  Tertiary eye care center, Bhubaneswar, India.
  
  
  METHODS
  Prospective comparative interventional cohort study.
  
  
  METHODS
  Under a uniform protocol, cataract surgery with posterior chamber intraocular lens (PC IOL) implantation was performed from September 27, 2006, to July 31, 2010 (Group 1). All eyes were evaluated 1 day, 7 days, and 5 weeks ± 1 (SD) postoperatively. Treatment of eyes suspected to have developed infectious endophthalmitis was managed by retina-vitreous surgeons. From August 1, 2010, to August 31, 2012, the same surgeons performed cataract surgery with PC IOL implantation in another group of eyes, in which they administered intracameral cefuroxime prophylaxis (Group 2). All other protocols of postoperative care and microbiological investigation of the vitreous samples were similar. The rate of clinical and culture-positive endophthalmitis was compared between the 2 study groups: eyes without intracameral cefuroxime (Group 1) and eyes with intracameral cefuroxime (Group 2).
  
  
  RESULTS
  The incidence of clinical endophthalmitis in Group 1 (0.155% [12/7756 eyes]) and in Group 2 (0.108% [8/7366 eyes]) was not significantly different (P = .57). The culture positivity rate in Group 1 (0.09 % [7 eyes]) and in Group 2 (0.04% [3 eyes]) was also not significantly different (P = .38). In the treatment without intracameral cefuroxime, there was a minimal, statistically insignificant increase in postoperative acute endophthalmitis (odds ratio, 1.42; 95% confidence interval, 0.53-4.02; P = .506).
  
  
  CONCLUSIONS
  There is not strong evidence to support use of intracameral cefuroxime to reduce the rate of acute endophthalmitis after cataract surgery; however, the marginal benefit might justify its use.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the L.V. Prasad Eye Institute, Odisha, India. Electronic address: savitri@lvpei.org.
authors.forename: Savitri
authors.initials: S
authors.lastname: Sharma
authors.affiliation: From the L.V. Prasad Eye Institute, Odisha, India.
authors.forename: Srikant K
authors.initials: SK
authors.lastname: Sahu
authors.affiliation: From the L.V. Prasad Eye Institute, Odisha, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Dhillon
authors.affiliation: From the L.V. Prasad Eye Institute, Odisha, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Das
authors.affiliation: From the L.V. Prasad Eye Institute, Odisha, India.
authors.forename: Suryasnata
authors.initials: S
authors.lastname: Rath
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002442:Ceftazidime / Q000627:therapeutic use; D002444:Cefuroxime / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007194:India; D056965:Injections, Intraocular; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002442:Ceftazidime; D002444:Cefuroxime