Effect of cefuroxime intracameral injection antibiotic prophylactic on postoperative endophthalmitis wound post-cataract: A meta-analysis

Authors: Wang M, Liu Y, Dong H.

Geographical coverage: Sweden, the UK, Spain, France, China, the USA, multicentre European studies, South Africa, Portugal, Israel, Ireland, India, and Brazil.

Sector: Post-cataract surgery

Sub-sector: Risk, prevention

Equity focus: Not reported

Study population: Patients with cataract

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background: Cataract surgery is the most frequently performed eye operation in developed countries. Its prevalence is rising due to ageing populations and advances in surgical technology. A rare but serious complication is postoperative endophthalmitis, usually caused by bacteria entering the eye through surgical wounds. Preventive antibiotics are commonly administered, yet their effectiveness and optimal method of delivery remain unclear. Randomised trials are challenging to conduct due to the rarity of the condition, meaning most evidence comes from observational studies. Previous meta-analyses have shown that intracameral cefuroxime reduces the risk of endophthalmitis, but these have evaluated only a limited range of treatment options. As such, uncertainty remains over the most effective antibiotic and mode of administration.

Objective: To assess the prophylactic antibacterial effect of intracameral cefuroxime injection on postoperative endophthalmitis following cataract surgery.

Main findings: The review included 22 studies published between 2005 and 2022, conducted in various countries, including Sweden, the UK, Spain, France, China, the USA, multicentre studies across Europe, South Africa, Portugal, Israel, Ireland, India, and Brazil.

In total, the studies included 1,167,197 participants. Of these, 1,004,425 received intracameral cefuroxime injections, while 162,772 received no antibiotic and served as controls. Findings showed that compared with no antibiotic, intracameral cefuroxime significantly reduced the risk of postoperative endophthalmitis (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.07 to 0.29, p = 0.001).

Methodology:

Searches were conducted in PubMed, Embase, the Cochrane Library, and Google Scholar to identify randomised controlled trials (RCTs), observational studies, and retrospective studies involving patients who had undergone cataract surgery. Studies published up to July 2022 and reporting on the effect of intracameral cefuroxime prophylaxis on postoperative endophthalmitis were included.

Identified articles were screened for eligibility, and relevant data were extracted. The methodological quality of the included studies was assessed using the Cochrane Collaboration’s risk-of-bias tools. Data were synthesised using fixed- or random-effects meta-analysis models, depending on the degree of heterogeneity. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated using a funnel plot.

Applicability/external validity: The authors noted that most of the included RCTs did not incorporate individual variables such as age, gender, or ethnicity into stratified models to explore their potential influence on results. Consequently, it was not possible to determine whether the findings were affected by these factors.

Geographic focus: Focus

No geographical restrictions were applied. The included studies were conducted in Sweden, the UK, Spain, France, China, the USA, multicentre European studies, South Africa, Portugal, Israel, Ireland, India, and Brazil.

Summary of quality assessment: Overall, there is low confidence in the conclusions of this review. The search strategy was comprehensive, and inclusion and exclusion criteria were clearly defined. Study quality was assessed using Cochrane’s risk-of-bias tools, and the characteristics of included studies were reported. Data synthesis was appropriately conducted using fixed- or random-effects meta-analysis models, depending on heterogeneity, which was assessed using the I² statistic. However, the review did not provide a list of excluded studies or specify whether language restrictions were applied. There was no indication that reference lists were checked or that authors or experts were contacted for additional data. The number of reviewers independently involved in screening and data extraction was not reported. Although study quality was assessed, the detailed findings of the risk-of-bias evaluations were not presented.