If an apple-a-day keeps the doctor away, what keeps away endophthalmitis? While endophthalmitis is rare, invasion of the globe during cataract surgery is a risk factor and must be taken into consideration before, during, and after the procedure. In an effort to better understand ways to prevent such a postoperative complication, the ESCRS (European Society of Cataract and Refractive Surgeons) endophthalmitis study coordinated 24 ophthalmology clinics/units across Europe to gather data. Researchers in this partially masked, placebo-controlled, randomized clinical trial enrolled 13,698 participants to evaluate the prophylactic effect of intracameral cefuroxime injection and/or perioperative levofloxacin eyedrops on the incidence of endophthalmitis after cataract surgery.
The ESCRS endophthalmitis study earns its landmark status as it was among the trailblazers of endophthalmitis prophylaxis as it relates to cataract surgery. The results of the study influenced surgical technique in the following years and widened the discussion on how to best prevent endophthalmitis after cataract surgery.
- Use of intracameral cefuroxime at the end of cataract surgery significantly reduced the risk of postoperative endophthalmitis.
- The total reported cases of endophthalmitis were nearly 5 times less in groups that utilized intracameral cefuroxime compared to those that did not (OR, 4.59; 95% CI, 1.74-12.08; P = 0.002).
- Cases of microbiologically proven endophthalmitis were more than 5 times less in groups that utilized intracameral cefuroxime compared to those that did not (OR, 5.32; 95% CI, 1.55-18.26; P = 0.008).