Tolerability of intracameral cefuroxime during cataract surgery in case of penicillin allergy

Abstract

Since the results of the ESCRS study in 2007 and then the AFSSAPS recommendations of 2011, postoperative endophthalmitis prophylaxis in cataract surgery has evolved toward intracameral cefuroxime. Penicillin allergy is frequent and is not considered as a contra-indication to cefuroxime injection, but cross-reactions do exist. The goal of this study was to assess the tolerability of intracameral cefuroxime in patients with a penicillin allergy. In this monocentric open prospective study, adult patients undergoing cataract surgery and declaring themselves penicillin-allergic were included. A subcutaneous test of cefuroxime was performed preoperatively. If negative, patients received the intracameral injection of cefuroxime at the conclusion of the surgical procedure. The primary assessment criteria, evaluated on the day after the surgery, was the occurrence of allergic reactions. Forty-eight eyes of 40 patients, 72 ± 8 years old, were included. Forty-three skin tests were performed: 1 was positive and one was unreliable. Thirty-six patients were examined in our center the day after the surgery: 2 presented a conjunctival allergic reaction. No severe anaphylactic reaction was reported. Of our patients, 95.3% declaring a penicillin allergy had a negative pre-operative cefuroxime test. According to literature, 80 to 90% of presumed penicillin allergic patients would not actually be allergic to cefuroxime. In our population, we reported 2 benign conjunctival cross-reactions. Intracameral cefuroxime injection during cataract surgery seems well-tolerated in penicillin-allergic patients with a negative preoperative skin test.