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First Author: J.Perez-Canales SPAIN
Co Author(s): J. Pérez-Santonja E. Campos-Mollo M. Linares-Company
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To evaluate the safety of intracameral injections of vancomycin in patients undergoing routine cataract surgery, as a prophylaxis measure of postoperative endophthalmitis.
Department of Ophthalmology, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain.
This prospective, randomized, controlled clinical trial comprised 42 eyes of 26 patients with a clinical diagnosis of cataract. Participants were divided in 2 groups: 23 eyes received an intracameral injection of vancomycin (1mg/0.1ml) and 19 eyes received an intracameral injection of cefuroxime (1mg/0.1ml). All patients underwent microincision phacoemulsification. Uncorrected visual acuity (UCVA), refraction, best corrected visual acuity (BCVA), corneal clarity, anterior chamber reaction (cells and flare), pachymetry, intraocular pressure (IOP), endothelial cell density (ECD) and macular thickness measured by optical coherence tomography (OCT) were evaluated at base line prior to phacoemulsification, and 1 week, 1 month and 3 months after surgery. Corneal clarity, anterior chamber reaction and IOP were also evaluated postoperatively at day 1. Data were registered and compared between both groups.
Anterior chamber cellular reaction was significantly higher in the vancomycin group 24 hours after surgery (p<0.04). The mean ECD significantly decreased within each group at the first week follow-up (p<0.001). At 1-month follow-up, preliminary results showed no statistically significant difference in endothelial cell loss between cefuroxime and vancomycin group (10.08% vs 14.14%, p=0.22). No significant differences in BCVA, corneal clarity, pachymetry, anterior chamber reaction and IOP were observed between both groups at 1-week and 1-month follow-up. Changes in macular thickness were not statistically significant in comparison with baseline. No adverse drug reaction was reported.
Intracameral injections of vancomycin as a prophylaxis method for postoperative endophthalmitis appears to be a safe procedure. No increased risk of anterior chamber inflammation, endothelial cell loss or posterior segment toxicity was observed compared to intracameral injections of cefuroxime.