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Intracameral cefuroxime in patients with penicillin allergy during cataract surgery: is it safe?

Poster Details

First Author: S.Ameen UK

Co Author(s):    J. Ho   J. Lowe   A. Mearza        

Abstract Details



Purpose:

A recent literature review suggests an overall 1% risk of cross reaction with the use of first generation cephalosporins in penicillin allergic patients (with only 1 case series reporting the risk to be as high as 27%). None of these studies assessed the safety of second or third generation cephalosporins. The European Society of Cataract & Refractive Surgeons endophthalmitis study demonstrated that intracameral injection of 1.0mg of cefuroxime at the end of cataract extraction surgery reduced the rate of postoperative endophthalmitis by 5 fold. It's use has therefore been recommended to prevent this devastating complication and has been adopted as best practice in many centres worldwide. Our aim was to identify the safety of administering intracameral cefuroxime in patients with penicillin allergy excluding those with a documented anaphylactic reaction.

Setting:

The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK

Methods:

Data was collected prospectively over a period of 1 month. Patients with documented penicillin allergy but no allergy to cephalosporin were identified. All patients with a history of penicillin related anaphylaxis were excluded. A standardised proforma was used and data collected included: age of patient, gender, eye operated on, type of penicillin allergy, any intra-operative complications and any documented intra-operative reaction. The patient's post-operative observations in recovery- blood pressure (BP), heart rate (HR), oxygen saturation (SaO2) and any other reported reaction (for example rash, nausea, vomiting) were also collected.

Results:

Data from a total of 50 cataract operations in 48 patients were collected. There were 11(22%) male patients and 39 (78%) female. The mean age of all the patients at time of surgery was 71 years. The surgery was performed by 19 primary surgeons with varying level of experience (from junior senior house officers to consultants). 20 of the operated eyes were right and 30 were left. Documented penicillin allergies included facial swelling in 2 (4%) patients, rash in 21 (42%) patients, shortness of breath 2 (4%) patients, and unknown in 25 (50%) patients. In total, there were 2 (4%) intra-operative complications- 1 posterior capsular rupture and 1 zonluar dialysis. All patients received intracameral cefuroxime intra-operatively. There were no documented immediate reactions at the operating table. Data collected from the recovery suite showed no delayed ocular or systemic reactions in any of the patients with mean post-op recovery BP: 148/74, mean post-op recovery HR: 71, and mean post-op recovery SaO2: 99% on room air. No patient developed subsequent endophthalmitis.

Conclusions:

No patient in our prospective series suffered an adverse event related to intracameral cefuruxime despite having a penicillin allergy and no patient developed endophthalmitis. The use of intracameral cefuroxime in patients with a range of documented penicillin allergies is safe. Given the clear benefits associated with reduction of endophthalmitis rates, it is difficult to justify not using it in this sub-group of patients. FINANCIAL INTEREST: NONE

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