Article Text

Download PDFPDF
Comparative analysis of the safety and efficacy of intracameral cefuroxime, moxifloxacin and vancomycin at the end of cataract surgery: a meta-analysis
  1. Randy C Bowen1,
  2. Andrew Xingyu Zhou2,
  3. Sailaja Bondalapati2,
  4. Thomas W Lawyer2,
  5. Karisa B Snow3,
  6. Patrick R Evans2,
  7. Tyler Bardsley2,
  8. Mary McFarland2,
  9. Matthew Kliethermes2,
  10. Dallas Shi2,
  11. Christina A Mamalis2,
  12. Tom Greene2,
  13. Christopher J Rudnisky4,
  14. Balamurali Krishna Ambati2
  1. 1 Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin, USA
  2. 2 Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA
  3. 3 Department of Pharmacy, University of Utah, Salt Lake City, Utah, USA
  4. 4 Department of Ophthalmology, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Randy C Bowen, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI 53705, USA; rcbowenMD{at}


Background Current practice methods are unclear as to the most safe and effective prophylactic pharmacotherapy and method of delivery to reduce postoperative endophthalmitis occurrence.

Methods A systematic review and meta-analysis using Meta-analysis of Observational Studies in Epidemiology guidelines was performed to compare the efficacy of intracameral cefuroxime, moxifloxacin and vancomycin in preventing postphacoemulsification cataract surgery endophthalmitis. A safety analysis of intracameral antibiotics was concurrently performed.

Data sources BIOSIS Previews, CINAHL,, Cochrane Library, Dissertations & Theses, EMBASE, PubMed, ScienceDirect and Scopus were searched from inception to January 2017. Data were pooled using a random effects model. All articles were individually reviewed and data were extracted by two independent reviewers. Funnel plot, risk of bias and quality of evidence analyses were performed.

Results Seventeen studies with over 900 000 eyes were included, which favoured the use of intracameral antibiotics at the end of cataract surgery (OR 0.20; 95% CI 0.13 to 0.32; P<0.00001). The average weighted postoperative endophthalmitis incidence rates with intracameral cefuroxime, moxifloxacin and vancomycin were 0.0332%, 0.0153% and 0.0106%, respectively. Secondary analyses showed no difference in efficacy between intracameral plus topical antibiotics versus intracameral alone (P>0.3). Most studies had low to moderate risk of bias. The safety analysis showed minimal toxicity for moxifloxacin. Dosing errors led to the majority of toxicities with cefuroxime. Although rare, vancomycin was associated with toxic retinal events.

Conclusion Intracameral cefuroxime and moxifloxacin reduced endophthalmitis rates compared with controls with minimal or no toxicity events at standard doses. Additionally, intracameral antibiotics alone may be as effective as intracameral plus topical antibiotics.

  • drugs
  • infection
  • treatment medical
  • treatment surgery

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors contributed to the design or acquisition of data, analysis or interpretation of data, and contributed to drafting or critically revising the article for important intellectual content and final approval of the version to be published.

  • Funding This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant 8UL1TR000105 (formerly UL1RR025764), National Institutes of Health (EY014800), and an unrestricted grant from Research to Prevent Blindness, New York, to the Department of Ophthalmology and Visual Sciences, University of Utah.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas