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Comment & Response
August 2015

Need for Antibiotic Prophylaxis for Pseudophakic Endophthalmitis—Reply

Author Affiliations
  • 1Center For Excellence in Eye Care, Miami, Florida
  • 2Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2015;133(8):971. doi:10.1001/jamaophthalmol.2015.1506

In Reply The European Society of Cataract and Refractive Surgeons reported in 2007 that the use of intracameral cefuroxime at the conclusion of cataract surgery was associated with a significantly lower rate of acute-onset postoperative endophthalmitis when compared with a control group.1 However, there was a markedly increased rate of endophthalmitis in the control group, which was much higher than contemporary rates. A subsequent survey of European countries regarding the European Society of Cataract and Refractive Surgeons guidelines indicated that this treatment was not universally followed even in Europe.2 Reasons for not using intracameral cefuroxime include potential contamination, rare anaphylaxis, and increased resistance among Staphylococcus species.3 A recent study (2015) reevaluating intracameral cefuroxime for endophthalmitis prophylaxis after cataract surgery was not able to identify a difference between this treatment (n = 7366 eyes) given from 2010 to 2012 (incidence = 0.108%) and a group treated similarly from 2006 to 2010 (n = 7756 eyes) before intracameral cefuroxime sodium was given at the conclusion of cataract surgery (incidence = 0.155%).4 Moxifloxacin is ineffective in approximately 40% of coagulase-negative Staphylococcus isolates. Therefore, we disagree with Carifi and colleagues, who “strongly support the use of a bolus of antibiotic drugs administered intracamerally at the end of the surgical procedure.”5

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