Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul-Aug;86(4):308-313.
doi: 10.5935/0004-2749.20230052.

Cost effectiveness of intracameral cefuroxime prophylaxis and its efficacy in preventing endophthalmitis after cataract surgery in a referral hospital

Lívia da Silva Conci  1 , Arthur Pinheiro Favarato  2 , Alexandre Grobberio Pinheiro  1
Affiliations

Cost effectiveness of intracameral cefuroxime prophylaxis and its efficacy in preventing endophthalmitis after cataract surgery in a referral hospital

Lívia da Silva Conci et al. Arq Bras Oftalmol. 2023 Jul-Aug.

Abstract
in English, Portuguese

Purpose: To present the results of a retrospective study regarding the clinical and economic impact of intracameral cefuroxime administration to prevent endophthalmitis during cataract surgery in a referral hospital.

Methods: This study included 16,902 eyes from patients who had undergone cataract surgery between 2013 and 2017. From May 2014 onwards, all patients received routine intracameral injections of 1 mg cefuroxime (10 mg/1 mL) after phacoemulsification. The prophylactic efficacy was evaluated using the relative risk ratio, whereas the economic impact was evaluated using number needed to treat to avoid endophthalmitis.

Results: Before introducing cefuroxime, 3,407 cataract surgeries were performed using the phacoemulsification technique, and 7 post-operatory cases of endophthalmitis occurred (0.2% incidence). After introducing the cefuroxime protocol, 13,495 surgeries were performed, and 4 endophthalmitis cases were registered (0.03% incidence). Cefuroxime was identified as a protective factor against the development of endophthalmitis [risk ratio = 14%, p=0.002, 95% confidence interval (CI) 95%, 4%-49%], with an economic impact of number needed to treat = 568. The potential savings with cefuroxime was approximately US $2,334.36 for every 568 patients treated.

Conclusion: The incidence of endophthalmitis decreased by 86% (risk ratio = 14%, p=0.002, 95% CI, 4%-49%) after introducing intracameral cefuroxime prophylaxis at the study hospital. The results presented herein provide strong evidence for the use of cefuroxime in endophthalmitis prophylaxis after phacoemulsification surgeries, outperforming the alter-native by providing both economic and clinical benefits.

Objetivo: Apresentar os resultados de um estudo retrospectivo sobre o impacto clínico e econômico da administração de cefuroxima intracameral para prevenir endoftalmite nas cirurgias de catarata em um hospital de referência.

Métodos: Este estudo incluiu 16.902 olhos de pacientes submetidos à cirurgia de catarata entre 2013 e 2017. A partir de maio de 2014, todos os pacientes receberam rotineiramente uma injeção intracameral de 1mg de cefuroxima (10mg/1mL) ao final da cirurgia de facoemulsificação. A eficácia da profilaxia foi avaliada usando o risco relativo e o impacto econômico foi avaliado com o número necessário para tratar para se evitar um caso de endoftalmite.

Resultados: Antes da introdução do protocolo da cefuroxima, foram realizadas 3.407 cirurgias de catarata por facoemulsificação e ocorreram 7 casos de endoftalmite pós-operatória (incidência de 0,2%). Após a introdução do protocolo da cefuroxima, foram realizadas 13.495 cirurgias e registrados 4 casos de endoftalmite (incidência de 0,03%). A cefuroxima foi um fator de proteção no desenvolvimento de endoftalmite (risco relativo = 14%, p=0,002, Intervalo de Confiança de 95% [IC 95%], 4% - 49%) e o impacto econômico do número necessário para tratar = 568. A economia potencial com a cefuroxima foi de aproximadamente US$ 2.334,36 para cada 568 pacientes tratados.

Conclusão: A incidência de endoftalmite diminuiu 86% (risco relativo = 14%, p=0,002, IC 95% 4% - 49%) desde a introdução da profilaxia com cefuroxima intracameral no hospital do estudo. Os resultados apresentados mostram forte evidência para o uso da cefuroxima na profilaxia da endoftalmite após cirurgias de facoemulsificação, por proporcionar economia de custos e benefício clínico.

PubMed Disclaimer

Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Comment in

References

    1. Results of the Endophthalmitis Vitrectomy Study A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol. 1995;113(12):1479–96. - PubMed
    1. Kamalarajah S, Silvestri G, Sharma N, Khan A, Foot B, Ling R, et al. Surveillance of endophthalmitis following cataract surgery in the UK.”. Eye (Lond) 2004;18(6):580–7. - PubMed
    1. Kernt M, Kampik A. Endophthalmitis: pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol. 2010;4:121–35. - PMC - PubMed
    1. Melo GB, Bispo PJ, Regatieri CV, Yu MC, Pignatari AC, Höfling-Lima AL. Incidence of endophthalmitis after cataract surgery (2002-2008) at a Brazilian university-hospital. Arq Bras Oftalmol. 2010;73(6):505–7. - PubMed
    1. Friling E, Lundström M, Stenevi U, Montan P. Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg. 2013;39(1):15–21. - PubMed

LinkOut - more resources