High dose cefuroxime causing retinal toxicity in a patient undergoing trabeculectomy

Ku, Jae Yee; Wong, Shiao Wei; Steeples, Laura R; Delaney, Claire; Parry, Neil R. A.; Fenerty, Cecilia

doi:10.1016/j.ajoc.2022.101343

Cited by 4 publications

(5 citation statements)

References 35 publications

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“…Animal models have shown that overdoses of intracameral cefuroxime can cause persistent structural damage to the retina [47]. Case reports have described rare but serious adverse effects such as macular edema, uveitis, vascular damage, and toxic anterior segment syndrome (TASS) [48,49]. It should be noted that several case reports were confounded by administering a greater dose than recommended, likely due to reconstitution or dilution errors [50 ▪▪ ].…”

Section: Adverse Events Associated With Intracameral Cefuroximementioning

confidence: 99%

Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

Lieu,

Jun,

Afshari

2023

Current Opinion in Ophthalmology

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Purpose of review We summarize evidence-based considerations regarding the use of intracameral antibiotics during cataract surgery. Recent findings The use of intraoperative intracameral antibiotics reduced the incidence of postcataract surgery endophthalmitis 3.5-fold, with an odds ratio ranging from 0.14 to 0.19. A survey of the American Society of Cataract and Refractive Surgery showed usage of intracameral injections of antibiotics increased by 16% in the United States between 2014 and 2021. The frequency of vancomycin usage has sharply dropped to 6%, while moxifloxacin is now the dominant choice at 83% among respondents. One analysis showed that 2500 patients need to be treated with intracameral antibiotics to prevent one case of endophthalmitis. A 500 μg intracameral moxifloxacin at $22 dollars per dose is cost-effective, including for patients with posterior capsular rupture (PCR). Summary Studies substantiate the safety and efficacy of intracameral antibiotics for endophthalmitis prophylaxis. Intracameral moxifloxacin and cefuroxime are the most common choices. While vancomycin shows potential for efficacy, further studies evaluating clinical outcomes are needed. Adverse events are rare and commonly due to errors in preparation. Topical antibiotics do not provide additional prophylactic benefits to intracameral regimens. Intracameral antibiotics given alone are cost-effective.

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Section: Adverse Events Associated With Intracameral Cefuroximementioning

confidence: 99%

Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

Lieu,

Jun,

Afshari

2023

Current Opinion in Ophthalmology

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“…Cefuroxime is a broad-spectrum cephalosporin antibiotic that is commonly used in ophthalmic surgery for prophylaxis to reduce the risk of post-operative infection. Intracameral cefuroxime and subconjunctival cefuroxime are commonly used during cataract surgery and trabeculectomy surgery, respectively [ 13 ]. It achieves its bactericidal effect through the inhibition of bacterial cell wall synthesis.…”

Section: Cefuroximementioning

confidence: 99%

“…Ocular adverse effects of cefuroxime include intraocular inflammation [ 14 ], macular infarction with cystoid macular edema [ 15 ], and cornea edema [ 16 ]. On optical coherence tomography (OCT), serous macular detachment and disruption of the ellipsoid zone have been reported in a few cases [ 13 ]. While still not fully understood, given that macular edema predominates in the outer nuclear layer, transient sodium–potassium pump dysfunction in the retinal pigment epithelium (RPE) might play a role in cefuroxime toxicity [ 14 ].…”

Section: Cefuroximementioning

confidence: 99%

“…Electrophysiologic changes are also seen in cefuroxime toxicity, which can result from the RPE dysfunction from cefuroxime toxicity. On ffERG, reductions in a-wave and b-wave amplitudes in dark-adapted and light-adapted conditions have been reported [ 13 , 14 , 17 ]. On the other hand, a case series noted that photopic b-wave amplitudes were normal and only a reduction in scotopic b-wave amplitudes was noted [ 14 ].…”

Section: Cefuroximementioning

confidence: 99%

“…The different results in photopic b-wave amplitudes may be related to the higher dose of cefuroxime in the case series (40–50 mg) compared to other studies with lower concentration (1–12.5 mg). Cefuroxime is also associated with reduced signals in all rings of mfERG [ 13 ]. Further investigations are needed to elucidate the relationship between cefuroxime dose and electrophysiologic changes.…”

Section: Cefuroximementioning

confidence: 99%

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Use of Visual Electrophysiology to Monitor Retinal and Optic Nerve Toxicity

et al. 2022

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It is important for clinicians to consider exposure to toxic substances and nutritional deficiencies when diagnosing and managing cases of vision loss. In these cases, physiologic damage can alter the function of key components of the visual pathway before morphologic changes can be detected by traditional imaging methods. Electrophysiologic tests can aid in the early detection of such functional changes to visual pathway components, including the retina or optic nerve. This review provides an overview of various electrophysiologic techniques, including multifocal electroretinogram (mfERG), full-field ERG (ffERG), electrooculogram (EOG), pattern electroretinogram (PERG), and visual evoked potential (VEP) in monitoring the retinal and optic nerve toxicities of alcohol, amiodarone, cefuroxime, cisplatin, deferoxamine, digoxin, ethambutol, hydroxychloroquine, isotretinoin, ocular siderosis, pentosane, PDE5 inhibitors, phenothiazines (chlorpromazine and thioridazine), quinine, tamoxifen, topiramate, vigabatrin, and vitamin A deficiency.

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Cefuroxime

2022

Reactions Weekly

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High dose cefuroxime causing retinal toxicity in a patient undergoing trabeculectomy

Cited by 4 publications

References 35 publications

Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

Use of Visual Electrophysiology to Monitor Retinal and Optic Nerve Toxicity

Cefuroxime

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