Posters

Clinical evaluation of the true volume of intracameral cefuroxime injected in cataract surgery

Poster Details

First Author: R.Patel UK

Co Author(s):    S. Virdee   R. Nitiahpapand   C. Gizzi   S. Balal   A. Sharma        

Abstract Details

Purpose:

Intracameral cefuroxime is standard practice following cataract surgery to prevent infectious endophthalmitis. The standard dose is 1.0 mg/0.1 ml. Both dilution errors during reconstitution and inaccurate volume administration can cause inadvertent effects from subtherapeutic and toxic doses. Toxicity can include corneal oedema, temporarily raised intraocular pressure, intraocular lens dislocation, macular oedema and permanent loss of vision. Subtherapeutic dosage risks endophthalmitis. We measured the volume of intracameral cefuroxime injected after cataract surgery to assess the true amount given.

Setting:

Two operating surgeons, single centre.

Methods:

26 patients underwent cataract surgery. All received cefuroxime injections, administered via a diabetic 1ml syringe. The syringe volume pre- and post-administration was recorded, and patients were routinely followed up to assess for complications.

Results:

Mean±SD of the pre- and post-injection volumes was 0.36±0.11 ml and 0.24±0.11 ml. The average volume injected was 0.12±0.02 ml. In three cases, accidental loss of cefuroxime prior to injection required repriming of the syringe and led to overdosage. In a further three cases, initial under dosing was only corrected following inspection of the syringe post-injection. No postoperative complications were identified on routine follow-up.

Conclusions:

The current administration process for intracameral cefuroxime is suboptimal. Variability in dosage risks toxicity or subtherapeutic administration. Preloading with exactly 0.1ml risks underdosage, due to observed and unobserved accidental losses prior to injection, especially on difficult paracentesis entry. Preloading with more than 0.1ml to compensate for accidental losses, risks overdosage. As injection is performed without direct visualisation of the syringe, we recommend routinely checking the syringe post-injection to ensure correct dosage. Development of a graduated prefilled syringe providing the surgeon with tactile feedback could provide additional safety, with its applications extending to other ophthalmic treatments, such as Mydrane injections.

Financial Disclosure:

None