Original Title: Profilaxis de la endoftalmitis postquirúrgica en cirugía del cristalino: cefuroxima y moxiflocacino intracamerular

Authors' objectives: The objective of this systematic review was to determine the effectiveness and cost-effectiveness of intracameral cefuroxime and moxifloxacin in the prophylaxis of postoperative endophthalmitis.

Authors' results and conclusions: RESULTS: The search in the electronic databases yielded 4 articles and the handsearch added three more references, so that eventually seven articles that met the inclusion criteria were included: a clinical trial described in two papers, four observational studies and one economic evaluation. All included studies evaluated the effectiveness of cefuroxime compared with other types of antibiotic prophylaxis or no prophylaxis. The economic evaluation included intracameral and topical moxifloxacin as one of the alternative scenarios. The only prospective clinical randomized trial on endophthalmitis prophylaxis with intracameral cefuroxime, conducted by the European Society of Cataract and Refractive Surgery (ESCRS) found cefuroxime significantly more effective than no prophylaxis, or the use of a topical antibiotic. Another four major observational studies confirmed these results. The economic evaluation compared 11 different antibiotic prophylaxis regimens and concluded that intracameral cefuroxime saved costs, taking into account the avoided costs of endophthalmitis prevented CONCLUSIONS: • The effectiveness of intracameral cefuroxime as prophylaxis of postoperative endophthalmitis was proved in a multicenter randomized clinical trial, whose results have been confirmed in other observational studies. • Prophylactic use of intracameral cefuroxime saved costs, taking into account the costs of prevented cases of endophthalmitis. Compared to other regimens of prophylactic antibiotics, intracameral cefuroxime shows one of the best cost-effectiveness ratios. • The review has not identified any studies of the effectiveness of prophylactic intracameral moxifloxacin. • The optimal choice of drugs for the prevention of endophthalmitis after cataract surgery hasn’t been established. Randomized clinical trials comparing different regimens of antibiotic prophylaxis of postoperative endophthalmitis are needed. Performing these trials is difficult, because the sample size, due to the low incidence of endophthalmitis, must be very large.

Authors' methods: We conducted a systematic review of scientific literature on the efficiency and effectiveness of intracameral moxifloxacin and cefuroxime for the prophylaxis of postoperative endophthalmitis in cataract surgery. The search was conducted in the databases of MEDLINE, EMBASE, SCI, CINAHL and CENTRAL, and also the references of relevant articles were manually reviewed. We included those studies that investigated the effectiveness and / or efficiency of intracameral cefuroxime and / or moxifloxacin, as prophylaxis of endophthalmitis in the lens surgery. The relevant outcome measure was the incidence rate of postoperative endophthalmitis. The measures of interest in economic evaluations were cost-effectiveness ratios and incremental cost effectiveness ratio (ICER), or alternatively the amount of resources used and the cost of each treatment. The quality of included studies was assessed by the instrument CASPE for critical reading of clinical trials, cohort studies and casecontrol studies. The methodological quality of economic evaluations was assessed according to the criteria of Drummond.

Project Status: Completed

Year Published: 2011

URL for published report: https://sescs.es/profilaxis-de-la-endoftalmitis-postquirurgica-en-cirugia-del-cristalino/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es