Effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis after cataract surgery

Abstract

Objective To evaluate the clinical effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis in patients after cataract surgery. Methods We retrospectively collected the clinical data from 28 845 patients undergoing cataract surgery in our hospital between January 2016 and December 2019, who received injection of low-concentration vancomycin (0.01 mg/mL, 0.1 mL; 13 068 eyes in 7 318 cases) or cefuroxime (10 mg/mL, 0.1 mL; 15 777 eyes in 8 935 cases) in the anterior chamber at the end of surgery for prevention of endophthalmitis. The patients' postoperative visual acuity, intraocular pressure, cornea, anterior chamber and intraocular lens under slit lamp, vitreous opacity with B-mode ultrasound, and laboratory culture results were analyzed to identify the patients with infectious endophthalmitis, and the treatments and outcomes of the patients were analyzed. Results The incidence of postoperative infectious endophthalmitis was 0.022 9% (3 eyes in 3 cases) in low-concentration vancomycin group and 0.012 7% (2 eyes in 2 cases) in cefuroxime group, showing a significant difference between the 2 groups (P < 0.025). The results of bacterial culture identified cases of infections with Pseudomonas aeruginosa (1 case) and Staphylococcus epidermidis (2 cases) in low-concentration vancomycin group and infections with fungus (1 case) and Streptococcus mitis (1 case) in cefuroxime group. The clinical manifestations of infectious endophthalmitis in the identified cases did not differ significantly between the cefuroxime group and vancomycin group. The treatments of postoperative endophthalmitis included anterior chamber washing and drug injection, intravitreal drug injection, vitrectomy, systemic antibiotic infusion, and local hormone/antibiotic treatment. After the treatments, the visual acuity was improved in all cases in vancomycin group, but remained unchanged in one case and deteriorated in another in cefuroxime group. None of the patients required enucleation. Conclusion The clinical effect of low-concentration vancomycin injection in the anterior chamber is not inferior to that of cefuroxime injection for prevention of postoperative infectious endophthalmitis after cataract surgery.

Keywords

• vancomycin
• cefuroxime
• infective endophthalmitis