- Design
- Retrospective national register cohort, Sweden, 2018–2024
- Population
- 979,534 cataract operations
- Primary outcome
- Postoperative endophthalmitis
- Effect
- 0.013% overall; cefuroxime 0.017%, cefuroxime + ampicillin 0.011%, moxifloxacin 0.010% (no significant difference)
The Swedish National Cataract Register recorded 979,534 operations between 2018 and 2024, with 131 cases of postoperative endophthalmitis — 0.013%, or about one in 7,500.
Male sex, ocular comorbidity and capsule complications were associated with higher odds. Better preoperative vision and immediately sequential bilateral surgery were associated with lower odds, though the authors attribute this mainly to case mix: these patients were younger with fewer complications.
Endophthalmitis rates were 0.017% with intracameral cefuroxime alone, 0.011% with cefuroxime plus ampicillin and 0.010% with moxifloxacin; none was significantly better. Enterococcal infections were commoner with cefuroxime alone, which does not cover enterococci, and cases treated with moxifloxacin more often recovered vision of 20/40 or better. Overall visual outcomes after endophthalmitis remained poor, with nearly half ending below 20/200.
Intracameral moxifloxacin is widely used in India. These data support continuing a routine intracameral antibiotic, with the choice guided by local organism patterns and availability rather than a clear superiority of one agent.
- Use a routine intracameral antibiotic at the end of cataract surgery; all three regimens here had very low endophthalmitis rates.
- Be aware that cefuroxime alone does not cover enterococci, which were commoner in cefuroxime-treated cases.
- Take extra care in patients with capsule complications or ocular comorbidity, who had higher odds of infection.
- Review vision and inflammation promptly after surgery; outcomes after endophthalmitis were poor in nearly half.
- Record your own endophthalmitis rate and organisms to inform local antibiotic choice.
Why it matters
With infection this rare, registry scale is the only way to compare regimens, and it found no clear winner.
Don't overread it
Observational register data cannot show one antibiotic is superior; differences in visual outcome rest on very few cases.
The statistics, in plain English
With only 131 infections among nearly a million operations, the differences between 0.010% and 0.017% amount to a few cases per 100,000 and were not statistically significant. The better visual outcome with moxifloxacin comes from small numbers of infected eyes.
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