The edition · Ophthalmology
Cefuroxime resistance has more than doubled in postcataract endophthalmitis
Two French tertiary centres tracked the organisms causing acute endophthalmitis across 23 years and found two-thirds of isolates now resistant to the drug most surgeons instil at the end of the case; plus how eight US centres treat endogenous fungal disease, and what the neurodevelopment evidence really says about anti-VEGF for retinopathy of prematurity.
The edition in brief
A 234-eye comparative cohort from two French tertiary centres set 126 cases of acute postcataract endophthalmitis from 2002 to 2007 against 108 from 2016 to 2025. Coagulase-negative staphylococci fell from 38 per cent to 25 per cent of isolates while Enterococcus faecalis rose from 2 per cent to 10 per cent and Gram-negatives from 3.1 to 7.3 per cent. Cefuroxime resistance rose from 26.0 per cent to 66.1 per cent (adjusted OR 3.75, 95 per cent CI 1.59 to 8.82), methicillin resistance among staphylococci from 30.3 per cent to 75.0 per cent, and multidrug-resistant phenotypes from 3.0 per cent to 37.5 per cent. Presentations were milder and fewer eyes needed vitrectomy. A retrospective cohort of 118 eyes in 87 patients with endogenous fungal endophthalmitis across eight US academic centres found the initial systemic route was chosen on systemic disease rather than on ocular findings; eyes started on intravenous antifungals underwent surgery less often on unadjusted comparison (21 versus 50 per cent) but the difference did not survive adjustment (OR 0.33, 95 per cent CI 0.10 to 1.06). Worse presenting vision and mould infection predicted worse final vision. The FDA approved a supplement to the ranibizumab-nuna biosimilar BYOOVIZ on 1 September 2026. A phase 3 trial of nightly 0.75 per cent phentolamine drops in 145 people with dim light disturbances improved mesopic low-contrast acuity and reduced glare, halos and starbursts over 14 days. An American Academy of Ophthalmology review of 26 studies found no evidence that neurodevelopmental outcomes differ between anti-VEGF and laser as primary treatment for retinopathy of prematurity, though no study was powered to answer that question.
Two-thirds of postcataract endophthalmitis isolates are now cefuroxime resistant
Cefuroxime resistance in acute postcataract endophthalmitis rose from 26 to 66 per cent across 23 years at two French centres, with Enterococcus faecalis and multidrug-resistant staphylococci both markedly commoner - know your own unit's isolates rather than assuming the old spectrum.
In endogenous fungal endophthalmitis, the systemic illness decides the route - not the eye
In endogenous fungal endophthalmitis, treat the systemic infection as the thing that sets the route and get the organism to genus, because mould rather than yeast carried over four times the odds of worse final vision.
FDA clears a supplement to the ranibizumab biosimilar BYOOVIZ
The FDA approved a supplement to the ranibizumab-nuna biosimilar BYOOVIZ on 1 September 2026; the scope is not stated in the approval record, so read the revised label before assuming anything changed for your patients.
Nightly phentolamine drops improved dim-light vision in a placebo-controlled phase 3 trial
Nightly 0.75 per cent phentolamine drops beat placebo over 14 days for mesopic low-contrast acuity and for glare, halos and starbursts, which makes it the first randomised evidence for treating dim light disturbance pharmacologically.
Screen Indian preterm infants by the Indian criteria, not the western ones
Use the wider Indian screening thresholds - 34 weeks or 2000 g, plus any infant with an unstable neonatal course - and fix the first examination date on the discharge summary before the baby leaves the unit.
No signal that anti-VEGF harms neurodevelopment in retinopathy of prematurity - and no study powered to find one
Neurodevelopmental risk should no longer decide anti-VEGF versus laser for retinopathy of prematurity - 20 of 26 studies including all three randomised trials found no difference - but say clearly that no study was powered to detect a small one.
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