The edition · Ophthalmology
Cefuroxime resistance in postcataract endophthalmitis has gone from a quarter to two-thirds
Two French centres compared 23 years of isolates: coagulase-negative staphylococci down, Enterococcus faecalis up fivefold, and methicillin resistance among staphylococci from 30% to 75%. Plus what happens when you defer treatment after polypoidal regression, switching biologics in refractory uveitis, and an FDA supplement for a ranibizumab biosimilar.
The edition in brief
Today's ophthalmology edition opens with a comparison of acute postcataract endophthalmitis at two French tertiary centres across two periods — 126 eyes from 2002-2007 and 108 from 2016-2025. Coagulase-negative staphylococci fell from 38% to 25% of isolates while Enterococcus faecalis rose from 2% to 10% and Gram-negative organisms from 3.1% to 7.3%. Cefuroxime resistance rose from 26.0% to 66.1% of tested isolates (adjusted OR 3.75, 95% CI 1.59-8.82), methicillin resistance among staphylococci from 30.3% to 75.0% (adjusted OR 6.75, 1.99-22.83), and multidrug-resistant phenotypes from 3.0% to 37.5%. Presentations were milder in the recent cohort. A prospective cohort at four Thai university hospitals followed 81 treatment-naive eyes with polypoidal choroidal vasculopathy given three monthly aflibercept injections. Forty per cent achieved complete polypoidal regression; of 26 followed on an as-needed regimen, 13 (50%, 95% CI 30-70%) recurred within two years. Fluid-free probability was 57% at week 24 and 53% at week 84. Among those recurring, median acuity change was -3.5 letters and 36% had new haemorrhage. A meta-analysis of 89 studies in anti-TNF refractory non-infectious uveitis found a pooled response rate of 83% after switching, with interclass switching outperforming intraclass in sensitivity analysis (85% versus 71%, P=0.044) at low certainty. And across a million adults in two biobanks, most recorded glaucoma cases carried no subtype at all.
The organisms causing postcataract endophthalmitis are not the ones prophylaxis was designed for
Assume cefuroxime-resistant and methicillin-resistant organisms in postcataract endophthalmitis, and confirm your empirical intravitreal regimen covers Enterococcus and Gram-negatives.
Half the eyes stayed dry after stopping treatment for regressed polypoidal disease
Offer as-needed treatment after complete polypoidal regression only with monthly follow-up through the first year, and warn the patient half of eyes recur.
FDA approves a supplement to the ranibizumab biosimilar Byooviz
Note the Byooviz supplement as an administrative licence action, and read the current label before assuming anything about it changed clinically.
Record the glaucoma subtype, even when you are not sure
Record the glaucoma subtype and the angle assessment behind it in every note, because most recorded cases carry neither.
In anti-TNF refractory uveitis, switching class beat switching agent
When a first anti-TNF fails in non-infectious uveitis and the choice is open, prefer switching to a different biologic class.
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