Effectiveness and Safety of an Intracameral Injection of Cefuroxime for the Prevention of Endophthalmitis After Cataract Surgery With or Without Perioperative Capsular Rupture

Daïen, Vincent; Papinaud, Laurence; Gillies, Mark C; Domerg, Caroline; Nagot, Nicolas; Lacombe, Sandy; Daurès, Jean Pierre; Carrière, Isabelle; Villain, Max

doi:10.1001/jamaophthalmol.2016.1351

Cited by 68 publications

(64 citation statements)

References 26 publications

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“…A single-use vial of cefuroxime, which requires only reconstitution and not dilution, was approved in Europe in 2012 (Thea Laboratories; Keating 2013). Numerous studies in Europe have reported increases in the use of intracameral antibiotics and corresponding decreases in rates of endophthalmitis following the increased use of cefuroxime (Barreau 2012; Beselga 2014; Daien 2016; Haripriya 2016; Jabbarvand 2016). Surveys should be conducted in one to two years to determine whether increased utilization of intracameral antibiotics leads to increased antibiotic resistance or other ocular complications, or both.…”

Section: Authors’ Conclusionmentioning

confidence: 99%

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Gower

Lindsley

Tulenko

et al. 2017

Cochrane Database of Systematic Reviews

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Background Endophthalmitis is a severe inflammation of the anterior or posterior (or both) chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection. Objectives To evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery compared with no prophylaxis or other form of prophylaxis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to December 2016),the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We used no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 6 December 2016. We also searched for additional studies that cited any included trials using the Science Citation Index. Selection criteria We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. We included trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic), or postoperative antibiotic prophylaxis for acute endophthalmitis. We excluded studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine or antibiotics for treating acute endophthalmitis after cataract surgery. Data collection and analysis Two review authors independently reviewed abstracts and full-text articles for eligibility, assessed the risk of bias for each included study, and abstracted data. Main results Five studies met the inclusion criteria for this review, including 101,005 adults and 132 endophthalmitis cases. While the sample size was very large, the heterogeneity of the study designs and modes of antibiotic delivery made it impossible to conduct a formal meta-analysis. Interventions investigated included the utility of adding vancomycin and gentamycin to the irrigating solution compared with standard balanced saline solution irrigation alone, use of intracameral cefuroxime with or without topical levofloxacin perioperatively, periocular penicillin injections and topical chloramphenicol-sulfadimidine drops compared with topical antibiotics alone, and mode of antibiotic delivery (subconjunctival versus retrobulbar injections; fixed versus separate instillation of gatifloxacin and prednisolone). The risk of bias among studies was low to unclear due to information not being reported. We identified one ongoing study. Two...

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Section: Authors’ Conclusionmentioning

confidence: 99%

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Gower

Lindsley

Tulenko

et al. 2017

Cochrane Database of Systematic Reviews

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“…In addition, the statistical power to assess the safety of drugs is often lacking in RCTs because side [23] . Using French medical-administrative databases and high statistical power, the EPISAFE collaborative program aims to further explore the safety of drugs and interventions, as we did recently for endophthalmitis after cataract surgery [24,25] . The EPISAFE collaborative group has regular meetings to coordinate research projects.…”

Section: Episafe Collaborative Programmentioning

confidence: 99%

“…The first found a decrease in endophthalmitis after cataract surgery from 2005 to 2014 and, within the same period, an increased use of intracameral antibiotics [24] . The second observed that with perioperative capsular rupture of the lens, the incidence of endophthalmitis was lower for patients with than without an intracameral injection of antibiotics, with no increased risk of cystoid macular edema [25] . Although cataract surgery is highly effective and relatively safe, surgical complications are still a major source of morbidity because of the high case load and the increasing number of cataract surgeries.…”

Section: Episafe Collaborative Program In Cataract Surgerymentioning

confidence: 99%

“…The date of death is valuable information recorded since 2008, and the cause of death was also retrieved in a previous study [36] . The SNIIR-AM is a useful data source to estimate the incidence and prevalence of rare diseases or complications such as postoperative endophthalmitis [24,25] . Mother-to-child studies are possible since this linkage was set up in 2012.…”

Section: In Epidemiologymentioning

confidence: 99%

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French Medical-Administrative Database for Epidemiology and Safety in Ophthalmology (EPISAFE): The EPISAFE Collaboration Program in Cataract Surgery

Daïen¹,

Korobelnik²,

Delcourt

et al. 2017

Ophthalmic Res

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Medical-administrative databases are an important source of big data to assess the epidemiology of diseases and interventions, compare drugs, and investigate rare adverse events. We describe the French national health insurance system databases and the Epidemiology and Safety (EPISAFE) collaboration program in ophthalmology and illustrate the paper with recent studies that used the databases to investigate cataract surgery. The Système national d'information inter-régime de l'assurance maladie (SNIIR-AM) is one of the largest databases of medical and administrative data for a general population, covering nearly 65 million people. The SNIIR-AM database links data for all outpatient-reimbursed health expenditures, hospitalization in all 1,546 French private or public healthcare facilities, and date of death. The use of this database provides information at the scale of the entire country, allowing measurement of the impact of changes in practices and new guidelines. Between 2009 and 2012, a total of 2,717,203 eyes in 1,817,865 patients underwent cataract surgery in France, and the incidence of cataract surgery increased from 9.86 to 11.08/1,000 person-years. The 4-year cumulative risk of retinal detachment was 0.99%, and patients <60 years of age were at higher risk of retinal detachment. The incidence of pseudophakic cystoid macular edema was 0.95%. From 2005 to 2014, from data including more than 6 million procedures, the incidence of endophthalmitis after cataract surgery decreased from 0.15 to 0.05%. The EPISAFE collaboration program encompasses the key issues facing ophthalmology, including public health and public policy concerning disease incidence and prevalence, safety and adverse event monitoring, and clinical guidelines.

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“…The European Society of Cataract and Refractive Surgeons (ESCRS) prospective multi-center interventional trial (and many other case–control, cross-sectional, and longitudinal studies) supported the hypothesis that the use of ICC at the conclusion of cataract surgery reduces the incidence of postoperative endophthalmitis. [45678910111213141516] It is estimated that two to four cases of endophthalmitis per 1000 surgeries can be avoided if surgeons adopt the use of ICC,[13] and the absence of an ICC prophylactic regimen at a dose of 1 mg/0.1 mL was associated with an almost 5-fold increase in the risk of postoperative endophthalmitis. [4] The injection is expedient, painless, and achieves high antibiotic concentrations in the immediate postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Risks of cefuroxime prophylaxis for postcataract endophthalmitis

Alabduljabbar

Stone

2017

Middle East Afr J Ophthalmol

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Effectiveness and Safety of an Intracameral Injection of Cefuroxime for the Prevention of Endophthalmitis After Cataract Surgery With or Without Perioperative Capsular Rupture

Cited by 68 publications

References 26 publications

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

French Medical-Administrative Database for Epidemiology and Safety in Ophthalmology (EPISAFE): The EPISAFE Collaboration Program in Cataract Surgery

Risks of cefuroxime prophylaxis for postcataract endophthalmitis

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