Risk of Macular Toxicity After Intra-Cameral 1mg/0.1 ml Cefuroxime for Endophthalmitis Prophylaxis in Phacoemulsification Cataract Surgery
Risk of Macular Toxicity and Cataract Surgery
DOI:
https://doi.org/10.54393/pjhs.v4i08.934Keywords:
Retinal Toxicity, Transient Macular Edema, Intracameral Cefuroxime, Endophthalmitis ProphylaxisAbstract
The world's leading culprit of preventable blindness is cataracts. For numerous decades, postoperative endophthalmitis has instilled terror as a potential complication of cataract surgery. Objective: To determine the frequency of retinal toxicity in terms of transient macular edema following using per-operative intracameral cefuroxime 1mg/0.1ml for endophthalmitis prophylaxis. Methods: A Descriptive case series was done at LRBT Eye Hospital, Lahore, from 15th Dec 2020 to 14th Jun 2021. A total number of 118 senile cataract patients were included. After cataract surgery, an intracameral 1 mg injection of cefuroxime was given to each patient. The optimally corrected visual acuity and macular thickness at the center of the retina on OCT were assessed postoperatively at week 1. If they were found to be elevated, it was labeled as retinal toxicity. Data were collected on data collection proforma. Results: The average age of the participants was 59.68 ± 5.28 years. Mean visual acuity before and after surgery was 2.01 ± 0.74 and 1.92 ± 0.94, respectively. Mean central macular thickness before and after surgery was 241.08 ± 4.73 and 248.74 ± 5.86 µm, respectively. There were 71 (60.17%) male and 47 (39.83%) female patients. There were 42 (35.59%) farmers, 40 (33.90%) job holders, 05 (4.24%) business people, and 31 (26.27%) non-working patients. Retinal toxicity was found in 54 (45.76%) patients. Conclusions: Intracameral injection of cefuroxime sodium can result in transient macular edema and retinal toxicity. In this study, retinal toxicity occurred in 45.8% of patients undergoing phacoemulsification.
References
Aslankurt M, Çekiç O, Andı İ, Dursun O. Transient macular edema after standard dose of intracameral cefuroxime injection during phacoemulsification. Canadian Journal of Ophthalmology. 2016 Oct; 51(5): e141-2. doi: 10.1016/j.jcjo.2016.05.008. DOI: https://doi.org/10.1016/j.jcjo.2016.05.008
Chylack LT, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, et al. The lens opacities classification system III. Archives of Ophthalmology. 1993 Jun; 111(6): 831-6. doi: 10.1001/archopht.1993.01090060119035. DOI: https://doi.org/10.1001/archopht.1993.01090060119035
Prevent Blindness America. Vision problems in the United States: Prevalence of adult vision impairment and age-related eye disease in America. 2008. [Last cited: 3rd Aug 2023]. Available at: https://preventblindness.org/wp-content/uploads/2013/04/VPUS_2008_update.pdf.
Bastawrous A, Mathenge W, Nkurikiye J, Wing K, Rono H, Gichangi M, et al. Incidence of visually impairing cataracts among older adults in Kenya. JAMA Network Open. 2019 Jun; 2(6): e196354. doi: 10.1001/jamanetworkopen.2019.6354. DOI: https://doi.org/10.1001/jamanetworkopen.2019.6354
Inoue T, Uno T, Usui N, Kobayakawa S, Ichihara K, Ohashi Y, et al. Incidence of endophthalmitis and the perioperative practices of cataract surgery in Japan: Japanese Prospective Multicenter Study for Postoperative Endophthalmitis after Cataract Surgery. Japanese Journal of Ophthalmology. 2018 Jan; 62: 24-30. doi: 10.1007/s10384-017-0545-6. DOI: https://doi.org/10.1007/s10384-017-0545-6
Semoun O, Bonnel S, Nicolas L, Pecha F, Allouch C, Borderie V, et al. Macular Thickness and Morphology After Cataract Surgery with Intracameral Cefuroxime. Investigative Ophthalmology & Visual Science. 2012 Mar; 53(14): 6699.
Xiao H, Liu X, Guo X. Macular edema with serous retinal detachment post-phacoemulsification followed by spectral domain optical coherence tomography: a report of two cases. BMC Research Notes. 2015 Dec; 8(1): 1-5. doi: 10.1186/s13104-015-1639-1. DOI: https://doi.org/10.1186/s13104-015-1639-1
Wong DC, Waxman MD, Herrinton LJ, Shorstein NH. Transient macular edema after intracameral injection of a moderately elevated dose of cefuroxime during phacoemulsification surgery. JAMA Ophthalmology. 2015 Oct; 133(10): 1194-7. doi: 10.1001/jamaophthalmol.2015.2421. DOI: https://doi.org/10.1001/jamaophthalmol.2015.2421
Zuo C, Mi L, Ye D, Guo X, Xiao H, Wu M, et al. Toxic retinopathy after phacoemulsification when the cefuroxime dilution is correct. Journal of Cataract & Refractive Surgery. 2018 Jan; 44(1): 28-33. doi: 10.1016/j.jcrs.2017.09.031. DOI: https://doi.org/10.1016/j.jcrs.2017.09.031
Ciulla TA, Starr MB, Masket S. Bacterial endophthalmitis prophylaxis for cataract surgery: an evidence-based update. Ophthalmology. 2002 Jan; 109(1): 13-24. doi: 10.1016/S0161-6420(01)00899-5. DOI: https://doi.org/10.1016/S0161-6420(01)00899-5
Gills JP. Antibiotics in irrigating solutions. Journal of Cataract & Refractive Surgery. 1987 May; 13(3): 344. doi: 10.1016/S0886-3350(87)80094-9. DOI: https://doi.org/10.1016/S0886-3350(87)80094-9
Montan PG, Wejde G, Setterquist H, Rylander M, Zetterström C. Prophylactic intracameral cefuroxime: evaluation of safety and kinetics in cataract surgery. Journal of Cataract & Refractive Surgery. 2002 Jun; 28(6): 982-7. doi: 10.1016/S0886-3350(01)01270-6. DOI: https://doi.org/10.1016/S0886-3350(01)01270-6
Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. Journal of Cataract and Refractive Surgery. 2007 Jun; 33(6): 978-88. doi: 10.1016/j.jcrs.2007.02.032. DOI: https://doi.org/10.1016/j.jcrs.2007.02.032
Faure C, Perreira D, Audo I. Retinal toxicity after intracameral use of a standard dose of cefuroxime during cataract surgery. Documenta Ophthalmologica. 2015 Feb; 130: 57-63. doi: 10.1007/s10633-014-9465-7. DOI: https://doi.org/10.1007/s10633-014-9465-7
Czajka MP, Byhr E, Olivestedt G, Olofsson EM. Endophthalmitis after small‐gauge vitrectomy: a retrospective case series from Sweden. Acta Ophthalmologica. 2016 Dec; 94(8): 829-35. doi: 10.1111/aos.13121. DOI: https://doi.org/10.1111/aos.13121
Cardascia N, Boscia F, Furino C, Sborgia L. Gentamicin-induced macular infarction in transconjunctival sutureless 25-gauge vitrectomy. International Ophthalmology. 2008 Oct; 28: 383-5. doi: 10.1007/s10792-007-9148-4. DOI: https://doi.org/10.1007/s10792-007-9148-4
Brouzas D, Moschos MM, Koutsandrea C, Davou S, Georgalas I. Gentamicin-induced macular toxicity in 25-gauge sutureless vitrectomy. Cutaneous and Ocular Toxicology. 2013 Sep; 32(3): 258-9. doi: 10.3109/15569527.2012.756504. DOI: https://doi.org/10.3109/15569527.2012.756504
Çiftçi S, Çiftçi L, Dağ U. Hemorrhagic retinal infarction due to inadvertent overdose of cefuroxime in cases of complicated cataract surgery: retrospective case series. American Journal of Ophthalmology. 2014 Feb; 157(2): 421-5. doi: 10.1016/j.ajo.2013.10.018. DOI: https://doi.org/10.1016/j.ajo.2013.10.018
Hancock HA, Guidry C, Read RW, Ready EL, Kraft TW. Acute aminoglycoside retinal toxicity in vivo and in vitro. Investigative Ophthalmology & Visual Science. 2005 Dec; 46(12): 4804-8. doi: 10.1167/iovs.05-0604. DOI: https://doi.org/10.1167/iovs.05-0604
Radhika M, Mithal K, Bawdekar A, Dave V, Jindal A, Relhan N, et al. Pharmacokinetics of intravitreal antibiotics in endophthalmitis. Journal of Ophthalmic Inflammation and Infection. 2014 Dec; 4(1): 1-9. doi: 10.1186/s12348-014-0022-z. DOI: https://doi.org/10.1186/s12348-014-0022-z
Besozzi G, Di Salvatore A, Cardillo D, Finzi A, Pinackatt JS, Baldi A, et al. Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety. Clinical Ophthalmology. 2018 Aug; 12: 1567-70. doi: 10.2147/OPTH.S170751. DOI: https://doi.org/10.2147/OPTH.S170751
Shaarawy A, Meredith TA, Kincaid M, Dick J, Aguilar E, Ritchie DJ, et al. Intraocular injection of ceftazidime: effects of inflammation and surgery. Retina. 1995 Jan; 15(5): 433-8. doi: 10.1097/00006982-199515050-00011. DOI: https://doi.org/10.1097/00006982-199515050-00011
Kwok AK, Hui M, Pang CP, Chan RC, Cheung SW, Yip CM, et al. An in vitro study of ceftazidime and vancomycin concentrations in various fluid media: implications for use in treating endophthalmitis. Investigative Ophthalmology & Visual Science. 2002 Apr; 43(4): 1182-8.
Lam PT, Young AL, Cheng LL, Tam PM, Lee VY. Randomized controlled trial on the safety of intracameral cephalosporins in cataract surgery. Clinical Ophthalmology. 2010 Dec; 4: 1499-504. doi: 10.2147/OPTH.S15602. DOI: https://doi.org/10.2147/OPTH.S15602
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments