title: Intracameral cefuroxime in the prevention of postoperative endophthalmitis: an experience from Hong Kong.
abstract: OBJECTIVE
  The purpose was to study the effect of introducing intracameral cefuroxime, which was compounded by a hospital pharmacy, on postoperative endophthalmitis in a tertiary eye centre in Hong Kong.
  
  
  METHODS
  All cases that underwent cataract surgeries over a 12-year period (January 2004 to December 2015) were included. The routine use of intracameral cefuroxime at the end of cataract surgery was introduced at our centre after April 2010. All cefuroxime aliquots were prepared by the hospital pharmacy using an aseptic compounding technique. The rates of postoperative endophthalmitis before April 2010 (Group 1, no intracameral cefuroxime) and after April 2010 (Group 2, routine use of intracameral cefuroxime) were compared.
  
  
  RESULTS
  A total of 30,428 eyes (7,332 in Group 1 and 23,096 in Group 2) were studied. Eight cases developed postoperative endophthalmitis (1.09 in 1000; 0.11 %) in Group 1 whereas no cases developed endophthalmitis (0 %) in Group 2. The rate of reduction was statistically significant (p < 0.0001). Seven out of eight cases of endophthalmitis were confirmed by positive culture. Organisms identified were Group G Streptococcus (two cases), Group B Streptococcus, Staphylococcus aureus, Serratia marcescens, and coagulase-negative Staphylococcus (two cases). Antibiotic susceptibility testing results were available in six cases. Four out of six organisms were susceptible to the penicillin group. No adverse events related to the use of intracameral cefuroxime were encountered.
  
  
  CONCLUSIONS
  The use of intracameral cefuroxime could significantly reduce the rate of postoperative endophthalmitis in a tertiary centre in Hong Kong. The use of aseptic compounding to prepare cefuroxime aliquots by hospital pharmacy appeared to be safe and efficacious.
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Alex Lap-Ki
authors.initials: AL
authors.lastname: Ng
authors.affiliation: Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong.|Wu Ho Loo Ning Cataract Centre, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.
authors.forename: Wilson Wai-Tat
authors.initials: WW
authors.lastname: Tang
authors.affiliation: Department of Ophthalmology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.|Wu Ho Loo Ning Cataract Centre, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.
authors.forename: Patrick Siu-Hung
authors.initials: PS
authors.lastname: Li
authors.affiliation: Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong. kennethli@rcsed.ac.uk.|Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong. kennethli@rcsed.ac.uk.|Department of Ophthalmology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong. kennethli@rcsed.ac.uk.|Wu Ho Loo Ning Cataract Centre, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong. kennethli@rcsed.ac.uk.
authors.forename: Kenneth Kai-Wang
authors.initials: KK
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction; D002444:Cefuroxime / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime
keywords: Cataract; Endophthalmitis; Intracameral cefuroxime