title: Effectiveness and Safety of an Intracameral Injection of Cefuroxime for the Prevention of Endophthalmitis After Cataract Surgery With or Without Perioperative Capsular Rupture.
abstract: Postoperative endophthalmitis (POE) often results in severe visual impairment. In clinical studies, an intracameral cefuroxime injection at the end of surgery was found to be effective at reducing the incidence of POE. Two important issues are the retinal safety of cefuroxime and its use for patients with perioperative capsular rupture where the risk of POE is dramatically increased.
  
  
  
  To assess the effectiveness and retinal safety of an intracameral injection of cefuroxime sodium for the prevention of POE and its possible use in cases of a perioperative capsular rupture of the lens.
  
  
  
  Population-based cohort study of patients 40 years of age or older who underwent cataract surgery at 1 of 1546 French health care facilities, public or private, and whose medical records were obtained from the national administrative database. Data analyses were performed between March and November 2015.
  
  
  
  The effectiveness and safety of the prophylactic injection of cefuroxime as measured by the incidence of POE and cystoid macular edema.
  
  
  
  From January 2010 to October 2014, a total of 3 351 401 eyes of 2 434 008 patients 40 years of age or older (58.9% were women, and the mean [SD] age was 73.9 [9.5] years) underwent cataract surgery; 1941 patients (0.08%) 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 = .001 for trend]) as the use of cefuroxime prophylactic injections increased (11.1%, 14.4%, 32.8%, 64.8%, and 79.1% in 2010, 2011, 2012, 2013, and 2014, respectively [P = .001 for trend]). After multivariate adjustment, the risk of POE was reduced with the use of cefuroxime (odds ratio, 0.61 [95% CI, 0.56-0.68]). The retinal safety of an injection of cefuroxime, which was assessed by multiadjusted odds of retinal cystoid macular edema, was not increased for patients receiving cefuroxime injections (odds ratio, 0.86 [95% CI, 0.71-1.05]). For patients with a perioperative capsular rupture of the lens (the major risk factor for POE), the incidence of POE was lower for those who received an injection of cefuroxime than for those who did not (0.37% vs 0.51%, respectively [P = .001]), whereas an increased risk of cystoid macular edema was not identified for those who received or did not receive an injection of cefuroxime (5.6% vs 7.3%, respectively [P = .12]).
  
  
  
  These data suggest that, in routine practice, the intracameral injection of cefuroxime at the conclusion of cataract surgery is associated with a lower risk of POE and is safe for patients with or without a perioperative capsular rupture. While these data might be used to support the consideration of its routine use to prevent POE, in the absence of a randomized clinical trial, they cannot prove a direct cause-and-effect relationship between the injection of cefuroxime and POE.
authors.affiliation: Department of Ophthalmology, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier, France2Department of Ophthalmology, University of Montpellier, Montpellier, France3Inserm, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Daien
authors.affiliation: Echelon Régional du Service Médical du Languedoc-Roussillon, Biostatistics Department, Montpellier, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Papinaud
authors.affiliation: The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gillies
authors.affiliation: Echelon Régional du Service Médical du Languedoc-Roussillon, Biostatistics Department, Montpellier, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Domerg
authors.affiliation: Department of Medical Information, Montpellier University Hospital, Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
authors.affiliation: Department of Biostatistics, Epidemiology, and Clinical Research, University of Montpellier, Montpellier, France.
authors.forename: Sandy
authors.initials: S
authors.lastname: Lacombe
authors.affiliation: Department of Biostatistics, Epidemiology, and Clinical Research, University of Montpellier, Montpellier, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Daures
authors.affiliation: Department of Ophthalmology, University of Montpellier, Montpellier, France3Inserm, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Carriere
authors.affiliation: Department of Ophthalmology, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier, France2Department of Ophthalmology, University of Montpellier, Montpellier, France.
authors.forename: Max
authors.initials: M
authors.lastname: Villain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000009:adverse effects / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D057851:Posterior Capsular Rupture, Ocular / Q000209:etiology*; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime