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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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Year : 2017  |  Volume : 24  |  Issue : 1  |  Page : 24-29

Risks of cefuroxime prophylaxis for postcataract endophthalmitis

1 Research Department, King Khaled Eye Specialist Hospital; College of Medicine, King Saud University, Riyadh, Kingdom of Saud Arabia
2 Research Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saud Arabia; Department of Ophthalmology, Wilmer Eye Institute of Johns Hopkins University, Baltimore, MD, USA

Correspondence Address:
Donald U Stone
King Khaled Eye Specialist Hospital, Arouba Road, P.O. Box 7191, Riyadh 11462, Kingdom of Saud Arabia

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/meajo.MEAJO_255_16

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Background: Endophthalmitis after cataract surgery is a rare but vision-threatening complication. Intracameral cefuroxime (ICC) has been reported to be effective at reducing the risk, but concerns regarding the risks associated with this intervention remain. Methods: Systematic review and synthesis of the literature on ICC, with a focus on the risks of therapy. Results: Level 2a evidence was found to support the use of cefuroxime in penicillin-allergic patients. Compounding or dilutional errors are associated with ocular toxicity, but the incidence and risk of this occurrence are unknown. Level 4 evidence supports interventions that reduce the risk of dilutional errors. The association of cefuroxime injection with toxic anterior segment syndrome (TASS) is not established; Level 5 evidence supports standard measures to reduce the incidence of TASS related to cefuroxime administration. Conclusion: Cefuroxime can be administered safely to penicillin-allergic patients, and steps should be taken to reduce the risk of compounding or dilutional errors to avoid negating the benefits of this intervention. Recommended practice patterns for endophthalmitis prophylaxis should consider the risks and benefits of ICC.

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