The edition · Ophthalmology
Cefuroxime resistance in post-cataract endophthalmitis rose from a quarter to two-thirds of isolates
A French 23-year comparison found more enterococci and far more methicillin and cefuroxime resistance; vitrectomised eyes carried nearly four times the risk of cystoid macular oedema after cataract surgery; and anti-VEGF for ROP showed no neurodevelopmental penalty in the studies available.
The edition in brief
A French two-centre comparison of 234 cases of acute post-cataract endophthalmitis found that between 2002–2007 and 2016–2025, coagulase-negative staphylococci fell from 38% to 25% of isolates while Enterococcus faecalis rose from 2% to 10%; cefuroxime resistance rose from 26% to 66% and methicillin resistance among staphylococci from 30% to 75%, although recent cases presented less severely. A US database cohort of 7318 matched pairs found prior vitrectomy was associated with cystoid macular oedema after cataract surgery in 4.59% vs 1.23% (RR 3.73). An American Academy of Ophthalmology evidence review of 26 studies found no consistent difference in neurodevelopmental outcomes between anti-VEGF and laser for retinopathy of prematurity, though no study was powered for it. A single-surgeon trial of 68 eyes found iStent inject and Kahook Dual Blade goniotomy with phaco gave similar pressure reduction (about 14%), and patients in both arms came off drops at six months. A US multicentre cohort of 118 eyes with endogenous fungal endophthalmitis found mould infection and poor presenting vision predicted worse outcome. Today's pearl covers the corneal ulcer that should not get steroid drops.
Vitrectomised eyes had nearly four times the risk of macular oedema after cataract surgery
Treat a previously vitrectomised eye as high-risk for CME after cataract surgery: counsel, consider NSAID prophylaxis and check the macula early.
Anti-VEGF for retinopathy of prematurity showed no consistent neurodevelopmental harm
Anti-VEGF and laser for ROP show no consistent difference in neurodevelopment; decide on ocular grounds and ensure developmental follow-up.
iStent inject and Kahook Dual Blade with phaco lowered pressure similarly, and patients came off drops
In mild glaucoma needing cataract surgery, iStent inject or goniotomy with phaco similarly reduce drops and pressure modestly.
Mould infection and poor presenting vision predicted worse outcome in endogenous fungal endophthalmitis
Examine the fundus in candidaemic patients (IDSA advises this even without eye symptoms) and in septic patients with eye symptoms, and treat mould endophthalmitis as the high-risk form it is.
Scrape the corneal ulcer before any steroid drop
Never put steroid drops on a corneal ulcer before scraping it; fungal keratitis is common and steroids make it worse.
Post-cataract endophthalmitis became more enterococcal and more cefuroxime-resistant
Treat post-cataract endophthalmitis empirically with intravitreal vancomycin and ceftazidime, and base prophylaxis on your own unit's resistance data.
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