Safety of intracameral cefuroxime in pars plana vitrectomy.

Szczegóły
Abstrakt

Tytuł:: Safety of intracameral cefuroxime in pars plana vitrectomy.
Autorzy:: Neffendorf JE; St. Thomas' Hospital, London, UK.
Kumaran N; St. Thomas' Hospital, London, UK.
Sandinha T; St. Paul's Eye Unit, Royal Liverpool Hospital, Liverpool, UK.
Wong RS; St. Thomas' Hospital, London, UK.
Laidlaw DAH; St. Thomas' Hospital, London, UK.
Williamson TH; St. Thomas' Hospital, London, UK. .
Źródło:: Eye (London, England) [Eye (Lond)] 2021 Sep; Vol. 35 (9), pp. 2601-2606. Date of Electronic Publication: 2020 Nov 20.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: <2003->: London : Nature Publishing Group
Original Publication: [London : Ophthalmological Society of the United Kingdom, 1987-
MeSH Terms:: Cataract Extraction*
Endophthalmitis*/epidemiology
Endophthalmitis*/etiology
Endophthalmitis*/prevention & control
Eye Infections, Bacterial*/drug therapy
Eye Infections, Bacterial*/epidemiology
Eye Infections, Bacterial*/prevention & control
Anterior Chamber ; Anti-Bacterial Agents/adverse effects ; Cefuroxime/adverse effects ; Cohort Studies ; Humans ; Postoperative Complications/epidemiology ; Retrospective Studies ; Vitrectomy
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Substance Nomenclature:: 0 (Anti-Bacterial Agents)
O1R9FJ93ED (Cefuroxime)
Entry Date(s):: Date Created: 20201121 Date Completed: 20210920 Latest Revision: 20220902
Update Code:: 20240105
PubMed Central ID:: PMC8377051
DOI:: 10.1038/s41433-020-01303-1
PMID:: 33219339
: Czasopismo naukowe

Background/objectives: Postoperative endophthalmitis is a rare, but serious complication of pars plana vitrectomy (PPV). Subconjunctival cefuroxime injection has been the traditional choice for post vitrectomy endophthalmitis prophylaxis. Its effectiveness and safety in this context are however poorly understood and cases of retinal toxicity have been reported. The traditional standard subconjunctival antibiotic prophylaxis has been superceded in cataract surgery by intracameral antibiotic prophylaxis.
Subjects/methods: The primary aim of this three centre non-randomised retrospective database cohort study of 7,532 PPV procedures was to identify the rate of endophthalmitis in cohorts of patients treated with intracameral or subconjunctival cefuroxime. A secondary aim was to estimate the achieved intraocular antibiotic concentrations of cefuroxime in eyes with intracameral versus subconjunctival administration using mathematical modelling.
Results: The overall incidence of postoperative endophthalmitis was 0.07% (5/7532). There were no cases of endophthalmitis in eyes receiving intracameral cefuroxime alone or in combination with subconjunctival cefuroxime (0/5586). Patients receiving subconjunctival cefuroxime alone had a higher incidence of endophthalmitis (0.22%, 4/1835), and there was one case of endophthalmitis in eyes not receiving any perioperative antibiotics (0.9%, 1/111). No cases of cefuroxime toxicity were identified. With subconjunctival cefuroxime, in the presence of a sclerotomy leak, we estimated the vitreous drug concentration to be higher than that for intracameral cefuroxime and potentially toxic.
Conclusions: Intracameral cefuroxime appears to be a safe and efficient choice for prophylaxis against endophthalmitis after PPV. Small eyes with intraocular tamponade seem to be at particular risk of drug toxicity if cefuroxime is administered via the subconjunctival route.
(© 2020. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

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