Prophylactic cefuroxime and endophthalmitis in Tanzania, East Africa

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In our view, there is little if any controversy about the use of intracameral cefuroxime for the prophylaxis of endophthalmitis.¹ Our unit in Dar es Salaam, Tanzania, had an unacceptably high level of postoperative endophthalmitis. We now perform 7000 intraocular cases annually, mainly cataract extractions with intraocular lenses using both small and large incisions. Additionally, we perform pars plana vitrectomy and a multitude of other types of cases. Nothing is more disheartening for patient, surgeon, and institution than the development of endophthalmitis after routine surgery. Despite using preoperative topical antibiotic agents as well as changing our sterilization practice, including the use of vacuum sterilizers, we continued to have a high rate of endophthalmitis of at least 1 case a month.

We introduced intracameral cefuroxime (1 mg) in December 2003 and have not looked back. Our endophthalmitis rate has decreased from approximately 1 case a month to none as of this date, 3 and one-half years later. This effectively translates to a decrease from 12 cases of endophthalmitis in 5000 cases (0.24%) in 2003 to no cases in 2004, 2005, and 2006 (0%) despite an increase in surgical volume to 7000 cases annually. The medication is prepared by us at our unit, and we have not documented any adverse reactions to intracameral cefuroxime over the past 3 years.

Although our observation and experience do not hold the value of a randomized controlled study, in our view the usefulness of intracameral cefuroxime is unquestionable, certainly in our environment where risks are high. Based on our positive experience, we have encouraged all hospitals in our network in East Africa to adopt this practice. For reasons that are not altogether clear, there has been some reluctance on the part of our colleagues but we are pleased that adoption of this practice is slowly occurring, with a commensurate reduction in endophthalmitis. For those in similar situations, we highly encourage the practice of injecting intracameral cefuroxime at the conclusion of intraocular surgery.

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Reference 

1. ESCRS Endophthalmitis Study Group . Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33:978–988
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