Endophthalmitis is a serious complication of cataract surgery that every ophthalmic surgeon – and patient – strives to avoid. The visual loss and debilitation that occur in a large proportion of postoperative endophthalmitis cases can be severe and irreversible.

Those most in need of the operation are often those at greatest risk, such as the elderly. Without knowing exactly how, when or why to intervene with effective prophylactic measures, virtually every surgeon today follows a standard of care that involves antisepsis and antibiotics.

Although cataract surgery ranks among the most frequently performed surgical procedures worldwide, data to define the most effective prophylactic measures have been nearly impossible to generate, given the large patient numbers needed to conduct clinical trials. Prevention and elimination of postoperative endophthalmitis, however, is a constant goal of every ophthalmic surgeon.

The clinical practice of administering a direct intracameral injection of cefuroxime at the close of cataract surgery to reduce endophthalmitis rates was first implemented by a group of Swedish surgeons. The clinical benefit of this intervention seemed apparent.

In order to test the hypothesis in a scientific manner, the European Society of Cataract and Refractive Surgeons mounted a large randomized clinical trial to evaluate the intracameral injection in a prospective, randomized fashion across nine European countries.

Results published in 2007 unequivocally demonstrated a clinical benefit, with a five-fold reduction in postoperative endophthalmitis rates in patients who received a 1mg intracameral injection of cefuroxime at the close of cataract surgery.

In the wake of these results, a growing number of centres have adopted this method of prophylaxis, reporting even more striking effects, on occasion, than the ESCRS study itself.

Presentations

FREE VIEW
EyeContact Interview: The Benefits of Intracameral Cefuroxime
Peter Barry | Source: EuroTimes Watch
FREE VIEW
Instructional Course: Endophthalmitis after cataract surgery & intravitreal injections
Luis Cordoves | Source: Recorded during the 2016 ESCRS Congress. Free for all to view. Full course schedule below video Watch
MEMBER ACCESS ONLY
iLearn Interactive Course: Prevention and management of endophthalmitis
| Source: ESCRS iLearn Portal. An interactive instructional course. Earn CME credits online by completing. Watch
MEMBER ACCESS ONLY
ESCRS Endophthalmitis Study: uptake of intracameral cefuroxime since 2006
Peter Barry | Source: ESCRS 2012 Congress. ESCRS on Demand Watch
MEMBER ACCESS ONLY
Endophthalmitis: Just another complication?
Peter Barry | Source: ESCRS 2010 Congress Main Symposium. ESCRS on Demand Watch
MEMBER ACCESS ONLY
The ESCRS endophthalmitis study: Micro and molecular biology and visual results
Peter Barry | Source: ESCRS 2008 Congress. ESCRS on Demand Watch
MEMBER ACCESS ONLY
Endophthalmitis following cataract surgery – Today and tomorrow
Peter Barry | Source: ESCRS 2008 Congress in the YO Programme. ESCRS on Demand Watch

    Download the endophthalmitis guidelines

    ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery:
    Data, Dilemmas and Conclusions

    Published Articles

    JCRS Article June 2007: Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors
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    Date Posted: 2018-08-21

    The landmark article from the ESCRS Endophthalmitis Study Group. This article has now been cited over 600 times.

    JCRS Article June 2002: Prophylactic intracameral cefuroxime: Evaluation of safety and kinetics in cataract surgery
    author-default
    Date Posted: 2018-09-12

    Per Montan et al. To evaluate the safety and kinetics of prophylactic intracameral cefuroxime in cataract surgery.

    JCRS Article June 2002: Prophylactic intracameral cefuroxime: Efficacy in preventing endophthalmitis after cataract surgery
    author-default
    Date Posted: 2018-09-12

    Per Montan et al. Presented at the XVIth Congress of the European Society of Cataract & Refractive Surgeons, Nice, France, September 1998, the XIIth meeting of the European Society of Ophthalmology, Stockholm, Sweden, June 1999, and the XIIIth meeting of the European Society of Ophthalmology, Istanbul, Turkey, June 2001.

    JCRS Article September 2013: Endophthalmitis prophylaxis in cataract surgery: Overview of current practice patterns in 9 European countries
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    Date Posted: 2018-08-21

    Data on practice patterns for prophylaxis against infectious postoperative endophthalmitis (IPOE) during cataract surgery in 9 European countries were searched in national registers and reviews of published surveys. Summary reports assessed each nation’s IPOE rates, nonantibiotic prophylactic routines, topical and intracameral antibiotic use, and coherence to the European Society of Cataract & Refractive Surgeons (ESCRS) 2007 guidelines.

    JCRS Article September 2009: Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery
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    Date Posted: 2018-08-21

    This article showed that swollen lids, pain, and an opaque vitreous were statistically associated with proven endophthalmitis cases in the ESCRS study.

    JCRS Article April 2009: United Kingdom survey of antibiotic prophylaxis practice after publication of the ESCRS Endophthalmitis Study
    author-default
    Date Posted: 2018-08-21

    The European Society of Cataract & Refractive Surgeons Endophthalmitis Study published preliminary results in 2006 showing a near 5-fold decrease in the rates of postoperative endophthalmitis with the use of intracameral cefuroxime. The study findings have generated considerable controversy, and 1 year later its recommendations had been heeded by only 6% of American Society of […]

    JCRS October 2007: Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: Potential role of moxifloxacin
    author-default
    Date Posted: 2018-08-21

    To aid the cataract surgeon’s understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. […]

    JCRS Article March 2006: ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Case for a European multicenter study
    author-default
    Date Posted: 2018-08-21

    One of the original arguments for adopting a multicenter study to investigate prophylaxis of postoperative endophthalmitis after cataract surgery:

    EuroTimes Article December 2015: Endophthalmitis debate goes from conflict to consensus
    author-default
    Date Posted: 2018-08-21

    Contention has slowly given way to consensus in the cross-Atlantic debate on the merits of intracameral antibiotic prophylaxis following cataract surgery, suggests a debate held at the 2015 American Society of Cataract and Refractive Surgery Symposium in San Diego.

    Ophthalmology 2016 Article: Comparative effectiveness of antibiotic prophylaxis in cataract surgery
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    Date Posted: 2018-08-21

    In the United States, an observational, longitudinal cohort study was carried out to examine the effect of topical and injected antibiotics on risk of endophthalmitis.

    315 246 eligible cataract procedures in 204 515 members of Kaiser Permanente, California, 2005–2012.

    

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