Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery

Delyfer, Marie-Noëlle; Rougier, Marie-Bénédicte; Leoni, Sandy; Zhang, Qiuhua; Dalbon, Francis; Colin, Joseph; Korobelnik, Jean‐François

doi:10.1016/j.jcrs.2010.08.047

Cited by 122 publications

(106 citation statements)

References 21 publications

(22 reference statements)

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“…Our study showed this change to be maintained at 2 years. Tehrani et al 2 3) 0.10 G 0.06 0.12 G 0.14 .194 4th-order spherical aberration (Z4,0) 0.21 G 0.14 0.11 G 0.12 .007* in total RMS wavefront error from preoperatively to all values postoperatively (P Z .008), which we did not observe in our study.…”

contrasting

confidence: 66%

Safety, efficacy, and effect of foldable phakic iris-claw intraocular lenses on higher-order aberrations: Two-year follow-up

Qasem¹,

Dooley²,

Darcy³

et al. 2012

Journal of Cataract and Refractive Surgery

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Dick et al. 1 described the 2-year safety and efficacy of the Artiflex phakic intraocular lens (pIOL) (prerelease version, Ophtec BV) and Tehrani et al. 2 described the effects of this pIOL on higher-order aberrations (HOAs). The pIOL was subsequently substantially modified before it was released commercially in its current form (Artiflex pIOL, version 401, Ophthec BV). The redesigned pIOL has an increased vault between the optic-haptic junction and the iris plane, resulting in greater apex to iris plane distance than in the prerelease version. 1 We performed a prospective study of the safety, efficacy, and effect of the newer version on HOAs, which has not been described. LogMAR corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refractive spherical equivalent (MRSE), endothelial cell density (ECD), and HOAs were recorded preoperatively and 6, 12, and 24 months after implantation of the pIOL.Implantation was performed by a single surgeon (M.O.K.) in 66 myopic eyes of 37 patients (mean MRSE À8.9 diopters [D] G 1.9 [SD]). At 24 months, the mean MRSE was À0.3 D; 69.4% of eyes had a UDVA of less than or equal to 0.0 logMAR and 100% had a UDVA of less than or equal to 0.18 logMAR. Laser-assisted subepithelial keratomileusis was performed in 6% of eyes to correct a residual refractive error. Thirty-two eyes (48.5%) gained 1 or more lines of CDVA, and no eye lost a line of CDVA. A statistically significant 17% decrease in the root mean square (RMS) of vertical trefoil Z(3,À1) was noted (P Z .016, Student t test, Table 1), and there was a statistically significant 48% decrease in 4th-order spherical aberration, Z(4,0), (P Z .007, Student t test, Table 1). The total HOAs were not significantly altered after surgery (PR.194, Student t test, Table 1). The mean ECD did not change significantly from preoperatively (3245 G 364 cells/mm 2 to 2 years postoperatively (3268 G 318 cells/mm 2 ; P Z 0.68, Student t test). Six months postoperatively, 2 patients (5%) reported subjective complaints of difficulty with night driving because of monocular night glare, which improved after a short course of topical brimonidine 0.15%.The results of this study compare favorably with those described by Dick et al., 1 who reported a mean CDVA of À0.01 at 2 years; in our study, the mean CDVA at 2 years was also À0.01. The efficacy index at 6 months and 1 year reported by Dick et al. (0.99 and 1.01, respectively) compared favorably with those of our study at the same periods (1.04 and 1.07, respectively). At 6 months and 1 year, Dick et al. 1 reported that 95.5% and 96.0% of cases, respectively, were within 1.0 D of intended correction; in our study, 92% and 86% of cases, respectively, met the same criteria.We had no cases of explantation or repositioning after 2 years compared with the rates reported by Dick et al. of 0.3% and 1.4%, respectively.

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contrasting

confidence: 66%

Safety, efficacy, and effect of foldable phakic iris-claw intraocular lenses on higher-order aberrations: Two-year follow-up

Qasem¹,

Dooley²,

Darcy³

et al. 2012

Journal of Cataract and Refractive Surgery

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“…Some cited the lack of a commercially available preparation that would eliminate the risk for dilution errors and the resulting ocular toxicity as their reason for not using it. 3 We have found intracameral cefuroxime to be an effective prophylaxis in our setting. South African ophthalmologists should be encouraged to use this prophylaxis.…”

Section: Endophthalmitis Prophylaxis With Intracameral Cefuroxime In mentioning

confidence: 70%

Endophthalmitis prophylaxis with intracameral cefuroxime in South Africa

Merwe¹,

Mustak²,

Cook³

2012

Journal of Cataract and Refractive Surgery

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“…A series of 6 cases was published by Delyfer et al documenting the inadvertent administration of high-dose (100 mg/mL) intracameral cefuroxime at the end of an uneventful cataract surgery, secondary to misunderstanding of the dilution protocol. 19 Each case resulted in moderate anterior inflammation and fibrin formation consistent with a mild form of toxic anterior segment syndrome or toxic endophthalmitis, which had resolved by day 5. All patients developed extensive macular edema with an associated serous retinal detachment on day 1 postoperatively, which significantly improved in the first week.…”

Section: Discussionmentioning

confidence: 93%

Safety Profile of Stromal Hydration of Clear Corneal Incisions with Cefuroxime in the Mouse Model

Moosajee

Tracey‐White²,

Harbottle

et al. 2016

Journal of Ocular Pharmacology and Therapeutics

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Purpose: The use of sutureless clear corneal incisions (CCIs) for phacoemulsification is an established surgical technique, but the dynamic morphology of the wound and poor construction can lead to an increased risk of postoperative endophthalmitis. Stromal hydration with balanced salt solution (BSS) can improve the selfsealing status. Intracameral cefuroxime has reduced endophthalmitis rates. This study investigates the safety profile of stromal hydration with cefuroxime, as sequestering antibiotic at the wound may potentially provide added protection against infection. Methods: MF-1 mice underwent bilateral CCI, followed by stromal hydration with 5 mL of 10 mg/mL cefuroxime, cefuroxime-texas red conjugate (for detection using confocal microscopy), or BSS. Corneas were harvested from 1 h to 12 weeks postoperatively; gross morphology, histology, and apoptotic cell death levels were investigated to determine the safety profile. Bactericidal activity of cefuroxime was assayed using homogenized whole cornea following stromal hydration at 1 h, 24 h, and day 7 against gram-negative Escherichia coli. Results: Cefuroxime stromal hydration did not alter corneal morphology, with no evidence of corneal scarring or vascularization. Corneal histology and levels of apoptosis were minimal and comparable to the BSS groups up to 12 weeks. Confocal microscopy detected cefuroxime-texas red up to 1 week surrounding the corneal wound. Whole corneal tissue homogenates displayed bactericidal activity up to 24 h postoperatively. Conclusions: Stromal hydration of CCI with cefuroxime is safe in mouse corneas. A reservoir of antibiotic at the wound can potentially act as a barrier of defense against infection following cataract and associated ocular surgery.

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Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery

Abstract: Intracameral injection of high doses of cefuroxime induced anterior and posterior inflammation. Without surgical intervention, the final visual outcome was satisfactory in all cases. Long-term retinal function, however, must be assessed through repeated ERG recordings.

Cited by 122 publications

References 21 publications

Safety, efficacy, and effect of foldable phakic iris-claw intraocular lenses on higher-order aberrations: Two-year follow-up

Safety, efficacy, and effect of foldable phakic iris-claw intraocular lenses on higher-order aberrations: Two-year follow-up

Endophthalmitis prophylaxis with intracameral cefuroxime in South Africa

Safety Profile of Stromal Hydration of Clear Corneal Incisions with Cefuroxime in the Mouse Model

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