Good Results

The introduction of intracameral cefuroxime for routine cataract surgery in a French private hospital significantly reduced the incidence of endophthalmitis and had a high clinical and economic impact on its prevention, according to a study presented at the annual meeting of the French Implant and Refractive Surgery Association (SAFIR) in Paris. “The evaluation of professional practices (EPP) carried out at our private hospital (Océane Private Hospital) showed that using intracameral cefuroxime in cataract surgery provides a clear benefit to the patient, with the prevalence of endophthalmitis reduced by a factor of 4.8 after its introduction. Our study also demonstrated the cost-effectiveness of intracameral cefuroxime use and makes a strong case for its introduction to the wider health system for every cataract intervention,” said Jean-Luc Bertholom MD.

The study conducted by Drs Bertholom, Raffray MD and Le Bail MD and colleagues, included 11,198 cataract surgeries carried out after the introduction of the intracameral cefuroxime protocol at a private hospital in Vannes, France, between 2011 and 2013. These results were then compared with a retrospective analysis of 9,999 cataract operations without cefuroxime carried out from 2007 to 2009.

Dr Bertholom noted that cataract surgery is the most practised form of surgery in France, with more than 700,000 operations a year, and an average endophthalmitis rate of 0.28 per cent. The cefuroxime protocol was instituted at the private hospital in Vannes according to recommended ESCRS guidelines, with an intracameral injection of 1mg cefuroxime in 0.1ml into the anterior chamber at the end of phacoemulsification surgery before closing the wound.

The results showed that the prevalence of endophthalmitis at the private hospital prior to the introduction of cefuroxime was 0.26 per cent, or 26 cases of endophthalmitis in 9,999 cataract operations. After the introduction of intracameral cefuroxime, however, the incidence was reduced to 0.05, or six cases in 11,198 cataract operations. Overall there was almost a five-fold (4.8) reduction in the incidence of endophthalmitis after the introduction of cefuroxime, said Dr Bertholom.

He noted that the results were comparable with those in the landmark ESCRS study published by Barry et al in JCRS in 2007, which recorded 23 (0.28 per cent) presumed cases of endophthalmitis in 8,244 patients that did not receive intracameral cefuroxime compared to five presumed cases (0.06 per cent) among the 7,997 patients that did receive intracameral cefuroxime.

Looking at the economic implications of antibiotic prophylaxis, Dr Bertholom estimated the cost of treating endophthalmitis at €7,500 per case or a total of €195,000 for the 26 cases recorded at Vannes prior to the use of cefuroxime. The cost of Aprokam, the first premixed intracameral cefuroxime formulation, is €9.10 per dose or €91,000 per 10,000 cataract surgeries.

“By avoiding an estimated 20.6 cases of endophthalmitis, which would cost around €154,000, we estimated the savings to be around €63,500 per 10,000 cataracts and €4,445,000 per 700,000 cataracts which is a very significant saving for the national health system if such a protocol was put in place nationally,” he concluded.

None of the authors has any commercial or financial interest in the products submitted.

Jean-Luc Bertholom: jeanluc.bertholom@gmail.com