- Design
- Retrospective national register cohort
- Population
- 979,534 cataract operations, Swedish National Cataract Register, 2018–2024
- Primary outcome
- Postoperative endophthalmitis
- Effect
- 0.013% overall; cefuroxime 0.017%, cefuroxime plus ampicillin 0.011%, moxifloxacin 0.010% (no significant difference)
The Swedish National Cataract Register captured 979,534 operations between 2018 and 2024. Endophthalmitis occurred after 131, an incidence of 0.013%, or about one in 7,500.
Rates were 0.017% with cefuroxime alone, 0.011% with cefuroxime plus ampicillin and 0.010% with moxifloxacin, and no regimen was significantly better after adjustment. Enterococcal infection was more common with cefuroxime, which does not cover it. When infection occurred, half of moxifloxacin cases recovered 20/40 vision against under a quarter with cefuroxime. Male sex, ocular comorbidity and capsule complications raised risk.
This is observational, and the very low event count limits comparisons. But the message for units is that using a reliable intracameral antibiotic consistently matters more than which one. In India, intracameral moxifloxacin is widely used and inexpensive, and these data support it; the higher risk with posterior capsule rupture is a reminder to manage that complication carefully.
- Give an intracameral antibiotic at the end of every cataract operation.
- Choose between cefuroxime and moxifloxacin on availability and cost; neither was significantly better.
- Note that cefuroxime does not cover enterococci.
- Take extra care after posterior capsule rupture, which raised endophthalmitis risk.
- Audit your own endophthalmitis rate against about one in 7,500.
Why it matters
It settles a common debate about which agent to use by showing the choice matters less than consistency.
Don't overread it
A register study with 131 events cannot show small differences between regimens.
The statistics, in plain English
Differences of a few thousandths of a percent between regimens are too small, with so few events, to be distinguished from chance.
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