Case Series Of Intracameral Cefuroxime-Induced Maculopathy Following Uncomplicated Cataract Surgery

Aprokam (intracameral cefuroxime) is the gold standard for prophylaxis against postoperative endophthalmitis in cataract surgery, with strong evidence for efficacy and safety. Rare cases of retinal toxicity and maculopathy have been reported. This study describes four cases of cefuroxime-induced maculopathy following uncomplicated cataract surgery, detailing clinical presentation, imaging findings, visual outcomes, and implications for postoperative monitoring.

This multicenter case series was conducted within a UK-wide independent cataract service provider (ISP) comprising of 66 hospitals. Four male patients were identified with cefuroxime-induced maculopathy across three separate sites in different regions. Cataract surgery was performed by three different surgeons using routine phacoemulsification with rountine intracameral cefuroxime administration at the end of surgery.

Four male patients aged 58–70 underwent uneventful cataract surgery with intracameral cefuroxime prophylaxis as per gold standard. Postoperative assessment included best-corrected visual acuity, intraocular pressure, slit-lamp examination, dilated fundus examination, and OCT. Patients presenting with visual disturbances were followed to document onset, severity, and resolution of macular changes, including serous retinal detachment, intraretinal fluid, and photoreceptor damage. Management was conservative, with serial observation and supportive care. All patients developed visual symptoms 1 to 3 days postoperatively, including central scotoma, blurred vision, and metamorphopsia with visual acuity ranging from CF to 0.50 (LogMAR). OCT revealed intraretinal and subretinal fluid consistent with cefuroxime-induced maculopathy. Two patients had complete resolution of visual acuity to logMAR 0.00 within one week with no intervention. The other two patients had persistent macular changes with visual acuity of 1.30 and 0.60. No anterior segment inflammation, retinal tears, or endophthalmitis occurred.

Cefuroxime-induced maculopathy is a rare but significant complication of cataract surgery. Correct dosing (1mg/0.1 ml), precise administration, and vigilance are critical to minimize risk. Nationwide ISP datasets enable tracking and linkage of infrequent adverse events, supporting early recognition, learning, and safety monitoring. Large-scale, structured data collection facilitates identification of uncommon phenomena, continuous quality improvement, and understanding of persistent photoreceptor damage.