Risk of Macular Toxicity After Intra-Cameral 1mg/0.1 ml Cefuroxime for Endophthalmitis Prophylaxis in Phacoemulsification Cataract Surgery

Risk of Macular Toxicity and Cataract Surgery


  • Muhammad Hannan Jamil Ophthalmology Department, Ali Fatima Hospital, Lahore, Pakistan
  • Sidra Zafar LRBT Eye Hospital, Lahore, Pakistan
  • Asmatullah Khan Ophthalmology Department, Ali Fatima Hospital, Lahore, Pakistan
  • Aneeb Ashraf Ophthalmology Department, Ali Fatima Hospital, Lahore, Pakistan
  • Muhammad Bilal Afzal Department of Public Health, University of the Punjab, Lahore, Pakistan
  • Ferheen Shahbaz Department of Public Health, University of the Punjab, Lahore, Pakistan https://orcid.org/0000-0003-4319-3722




Retinal Toxicity, Transient Macular Edema, Intracameral Cefuroxime, Endophthalmitis Prophylaxis


The world's leading culprit of preventable blindness is cataracts. For numerous decades, postoperative endophthalmitis has instilled terror as a potential complication of cataract surgery. Objective: To determine the frequency of retinal toxicity in terms of transient macular edema following using per-operative intracameral cefuroxime 1mg/0.1ml for endophthalmitis prophylaxis. Methods: A Descriptive case series was done at LRBT Eye Hospital, Lahore, from 15th Dec 2020 to 14th Jun 2021. A total number of 118 senile cataract patients were included. After cataract surgery, an intracameral 1 mg injection of cefuroxime was given to each patient. The optimally corrected visual acuity and macular thickness at the center of the retina on OCT were assessed postoperatively at week 1. If they were found to be elevated, it was labeled as retinal toxicity. Data were collected on data collection proforma. Results: The average age of the participants was 59.68 ± 5.28 years. Mean visual acuity before and after surgery was 2.01 ± 0.74 and 1.92 ± 0.94, respectively. Mean central macular thickness before and after surgery was 241.08 ± 4.73 and 248.74 ± 5.86 µm, respectively. There were 71 (60.17%) male and 47 (39.83%) female patients. There were 42 (35.59%) farmers, 40 (33.90%) job holders, 05 (4.24%) business people, and 31 (26.27%) non-working patients. Retinal toxicity was found in 54 (45.76%) patients. Conclusions: Intracameral injection of cefuroxime sodium can result in transient macular edema and retinal toxicity. In this study, retinal toxicity occurred in 45.8% of patients undergoing phacoemulsification.


Aslankurt M, Çekiç O, Andı İ, Dursun O. Transient macular edema after standard dose of intracameral cefuroxime injection during phacoemulsification. Canadian Journal of Ophthalmology. 2016 Oct; 51(5): e141-2. doi: 10.1016/j.jcjo.2016.05.008. DOI: https://doi.org/10.1016/j.jcjo.2016.05.008

Chylack LT, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, et al. The lens opacities classification system III. Archives of Ophthalmology. 1993 Jun; 111(6): 831-6. doi: 10.1001/archopht.1993.01090060119035. DOI: https://doi.org/10.1001/archopht.1993.01090060119035

Prevent Blindness America. Vision problems in the United States: Prevalence of adult vision impairment and age-related eye disease in America. 2008. [Last cited: 3rd Aug 2023]. Available at: https://preventblindness.org/wp-content/uploads/2013/04/VPUS_2008_update.pdf.

Bastawrous A, Mathenge W, Nkurikiye J, Wing K, Rono H, Gichangi M, et al. Incidence of visually impairing cataracts among older adults in Kenya. JAMA Network Open. 2019 Jun; 2(6): e196354. doi: 10.1001/jamanetworkopen.2019.6354. DOI: https://doi.org/10.1001/jamanetworkopen.2019.6354

Inoue T, Uno T, Usui N, Kobayakawa S, Ichihara K, Ohashi Y, et al. Incidence of endophthalmitis and the perioperative practices of cataract surgery in Japan: Japanese Prospective Multicenter Study for Postoperative Endophthalmitis after Cataract Surgery. Japanese Journal of Ophthalmology. 2018 Jan; 62: 24-30. doi: 10.1007/s10384-017-0545-6. DOI: https://doi.org/10.1007/s10384-017-0545-6

Semoun O, Bonnel S, Nicolas L, Pecha F, Allouch C, Borderie V, et al. Macular Thickness and Morphology After Cataract Surgery with Intracameral Cefuroxime. Investigative Ophthalmology & Visual Science. 2012 Mar; 53(14): 6699.

Xiao H, Liu X, Guo X. Macular edema with serous retinal detachment post-phacoemulsification followed by spectral domain optical coherence tomography: a report of two cases. BMC Research Notes. 2015 Dec; 8(1): 1-5. doi: 10.1186/s13104-015-1639-1. DOI: https://doi.org/10.1186/s13104-015-1639-1

Wong DC, Waxman MD, Herrinton LJ, Shorstein NH. Transient macular edema after intracameral injection of a moderately elevated dose of cefuroxime during phacoemulsification surgery. JAMA Ophthalmology. 2015 Oct; 133(10): 1194-7. doi: 10.1001/jamaophthalmol.2015.2421. DOI: https://doi.org/10.1001/jamaophthalmol.2015.2421

Zuo C, Mi L, Ye D, Guo X, Xiao H, Wu M, et al. Toxic retinopathy after phacoemulsification when the cefuroxime dilution is correct. Journal of Cataract & Refractive Surgery. 2018 Jan; 44(1): 28-33. doi: 10.1016/j.jcrs.2017.09.031. DOI: https://doi.org/10.1016/j.jcrs.2017.09.031

Ciulla TA, Starr MB, Masket S. Bacterial endophthalmitis prophylaxis for cataract surgery: an evidence-based update. Ophthalmology. 2002 Jan; 109(1): 13-24. doi: 10.1016/S0161-6420(01)00899-5. DOI: https://doi.org/10.1016/S0161-6420(01)00899-5

Gills JP. Antibiotics in irrigating solutions. Journal of Cataract & Refractive Surgery. 1987 May; 13(3): 344. doi: 10.1016/S0886-3350(87)80094-9. DOI: https://doi.org/10.1016/S0886-3350(87)80094-9

Montan PG, Wejde G, Setterquist H, Rylander M, Zetterström C. Prophylactic intracameral cefuroxime: evaluation of safety and kinetics in cataract surgery. Journal of Cataract & Refractive Surgery. 2002 Jun; 28(6): 982-7. doi: 10.1016/S0886-3350(01)01270-6. DOI: https://doi.org/10.1016/S0886-3350(01)01270-6

Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. Journal of Cataract and Refractive Surgery. 2007 Jun; 33(6): 978-88. doi: 10.1016/j.jcrs.2007.02.032. DOI: https://doi.org/10.1016/j.jcrs.2007.02.032

Faure C, Perreira D, Audo I. Retinal toxicity after intracameral use of a standard dose of cefuroxime during cataract surgery. Documenta Ophthalmologica. 2015 Feb; 130: 57-63. doi: 10.1007/s10633-014-9465-7. DOI: https://doi.org/10.1007/s10633-014-9465-7

Czajka MP, Byhr E, Olivestedt G, Olofsson EM. Endophthalmitis after small‐gauge vitrectomy: a retrospective case series from Sweden. Acta Ophthalmologica. 2016 Dec; 94(8): 829-35. doi: 10.1111/aos.13121. DOI: https://doi.org/10.1111/aos.13121

Cardascia N, Boscia F, Furino C, Sborgia L. Gentamicin-induced macular infarction in transconjunctival sutureless 25-gauge vitrectomy. International Ophthalmology. 2008 Oct; 28: 383-5. doi: 10.1007/s10792-007-9148-4. DOI: https://doi.org/10.1007/s10792-007-9148-4

Brouzas D, Moschos MM, Koutsandrea C, Davou S, Georgalas I. Gentamicin-induced macular toxicity in 25-gauge sutureless vitrectomy. Cutaneous and Ocular Toxicology. 2013 Sep; 32(3): 258-9. doi: 10.3109/15569527.2012.756504. DOI: https://doi.org/10.3109/15569527.2012.756504

Çiftçi S, Çiftçi L, Dağ U. Hemorrhagic retinal infarction due to inadvertent overdose of cefuroxime in cases of complicated cataract surgery: retrospective case series. American Journal of Ophthalmology. 2014 Feb; 157(2): 421-5. doi: 10.1016/j.ajo.2013.10.018. DOI: https://doi.org/10.1016/j.ajo.2013.10.018

Hancock HA, Guidry C, Read RW, Ready EL, Kraft TW. Acute aminoglycoside retinal toxicity in vivo and in vitro. Investigative Ophthalmology & Visual Science. 2005 Dec; 46(12): 4804-8. doi: 10.1167/iovs.05-0604. DOI: https://doi.org/10.1167/iovs.05-0604

Radhika M, Mithal K, Bawdekar A, Dave V, Jindal A, Relhan N, et al. Pharmacokinetics of intravitreal antibiotics in endophthalmitis. Journal of Ophthalmic Inflammation and Infection. 2014 Dec; 4(1): 1-9. doi: 10.1186/s12348-014-0022-z. DOI: https://doi.org/10.1186/s12348-014-0022-z

Besozzi G, Di Salvatore A, Cardillo D, Finzi A, Pinackatt JS, Baldi A, et al. Intracameral cefuroxime in combined pars plana vitrectomy and phacoemulsification: a study of safety. Clinical Ophthalmology. 2018 Aug; 12: 1567-70. doi: 10.2147/OPTH.S170751. DOI: https://doi.org/10.2147/OPTH.S170751

Shaarawy A, Meredith TA, Kincaid M, Dick J, Aguilar E, Ritchie DJ, et al. Intraocular injection of ceftazidime: effects of inflammation and surgery. Retina. 1995 Jan; 15(5): 433-8. doi: 10.1097/00006982-199515050-00011. DOI: https://doi.org/10.1097/00006982-199515050-00011

Kwok AK, Hui M, Pang CP, Chan RC, Cheung SW, Yip CM, et al. An in vitro study of ceftazidime and vancomycin concentrations in various fluid media: implications for use in treating endophthalmitis. Investigative Ophthalmology & Visual Science. 2002 Apr; 43(4): 1182-8.

Lam PT, Young AL, Cheng LL, Tam PM, Lee VY. Randomized controlled trial on the safety of intracameral cephalosporins in cataract surgery. Clinical Ophthalmology. 2010 Dec; 4: 1499-504. doi: 10.2147/OPTH.S15602. DOI: https://doi.org/10.2147/OPTH.S15602



DOI: 10.54393/pjhs.v4i08.934
Published: 2023-08-31

How to Cite

Jamil, M. H., Zafar, S., Khan, A., Ashraf, A., Afzal, M. B., & Shahbaz , F. . (2023). Risk of Macular Toxicity After Intra-Cameral 1mg/0.1 ml Cefuroxime for Endophthalmitis Prophylaxis in Phacoemulsification Cataract Surgery: Risk of Macular Toxicity and Cataract Surgery. Pakistan Journal of Health Sciences, 4(08), 57–61. https://doi.org/10.54393/pjhs.v4i08.934



Original Article

Most read articles by the same author(s)