{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T06:53:14Z","timestamp":1781506394138,"version":"3.54.1"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: The objective of this study was to evaluate macular perfusion changes after intracameral injection (ICI) of cefuroxime at the end of phacoemulsification. Methods: Patients who underwent routine phacoemulsification were enrolled. Subjects in the case group had ICI 1 mg\/0.1 mL cefuroxime at the end of surgery. Using optical coherence tomography angiography (OCT-A), macular perfusions were assessed at T0 (before surgery), T1, T10, T30, and T90 (days after surgery). Perfusion parameters were calculated in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). Independent t-tests were used to compare the changes from baseline in each parameter between groups. Results: A total of 33 eyes in the case group and 27 eyes in the control group were enrolled. After surgery, the case group showed a less pronounced reduction in the foveal avascular zone (FAZ) in the DCP at T10 (\u22120.06 \u00b1 0.23 vs. \u22120.18 \u00b1 0.18 mm2, p = 0.041) and T30 (\u22120.04 \u00b1 0.20 vs. \u22120.16 \u00b1 0.24 mm2, p = 0.050). At T90, there was no statistically significant difference in the FAZ change in the DCP between the groups. The postoperative changes in the vessel density, skeleton density, and acircularity index of the FAZ in the SCP and DCP, central retinal thickness, and best-corrected visual acuity were similar between the groups in all 3 months. Conclusions: Our findings indicate that intraoperative ICI low-dose cefuroxime is associated with a temporary deceleration in FAZ reduction in the DCP during the first postoperative month. From a personalized medicine perspective, these layer-specific microanatomic variations suggest that, while prophylactic cefuroxime is globally safe\u2014demonstrating no evidence of inducing capillary dropout, aggravating macular thickening, or compromising visual outcomes within this cohort\u2014preoperative and postoperative OCT-A monitoring can serve as an individualized screening framework to track subclinical perfusion dynamics, especially in patients with compromised retinal baselines.<\/jats:p>","DOI":"10.3390\/jpm16060320","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:59:47Z","timestamp":1781503187000},"page":"320","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Layer-Specific Retinal Perfusion as a Personalized Biomarker: Evaluating the Subclinical Microanatomical Effects of Intracameral Cefuroxime After Routine Cataract Surgery"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4850-3470","authenticated-orcid":false,"given":"Chia-Yu","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Taipei Tzu Chi Hospital, New Taipei City 23142, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4130-7703","authenticated-orcid":false,"given":"Chun-Yao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Medical Education, National Taiwan University Hospital, Taipei City 100225, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6234-6762","authenticated-orcid":false,"given":"Yi-Jie","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Taipei Tzu Chi Hospital, New Taipei City 23142, Taiwan"},{"name":"Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan City 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1001\/jamaophthalmol.2016.1351","article-title":"Effectiveness and Safety of an Intracameral Injection of Cefuroxime for the Prevention of Endophthalmitis After Cataract Surgery With or Without Perioperative Capsular Rupture","volume":"134","author":"Daien","year":"2016","journal-title":"JAMA Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.18240\/ijo.2025.10.24","article-title":"Systematic review of retinal toxicity after injection of cefuroxime during cataract surgery","volume":"18","author":"Wang","year":"2025","journal-title":"Int. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jcrs.2017.09.031","article-title":"Toxic retinopathy after phacoemulsification when the cefuroxime dilution is correct","volume":"44","author":"Zuo","year":"2018","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000543837","article-title":"Cefuroxime-Induced Toxic Maculopathy after Intracameral Injection of Standard Dose: A Case Report","volume":"16","author":"Pantelidou","year":"2025","journal-title":"Case Rep. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100905","DOI":"10.1016\/j.ajoc.2020.100905","article-title":"Acute macular edema and serous detachment on the first day after phacoemulsification surgery: A case report","volume":"20","year":"2020","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e247772","DOI":"10.1136\/bcr-2021-247772","article-title":"Acute exudative serous macular detachment with intraretinal oedema following uncomplicated phacoemulsification cataract surgery","volume":"15","author":"Spackman","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1159\/000526449","article-title":"Macular Toxicity of Low-Concentration Cefuroxime during Cataract Surgery in Vitrectomized Eyes","volume":"66","author":"Sun","year":"2023","journal-title":"Ophthalmic Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"615","DOI":"10.3928\/23258160-20211027-01","article-title":"Macular Edema and Serous Macular Detachment after a Standard Dose of Intracameral Cefuroxime","volume":"52","author":"Davila","year":"2021","journal-title":"Ophthalmic Surg. Lasers Imaging Retin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1007\/s40123-025-01137-8","article-title":"Structural and Functional Insight into Intracameral Cefuroxime Ocular Toxic Syndrome (ICOTS) in Eyes with Disrupted Intraocular Barrier","volume":"14","author":"Cusumano","year":"2025","journal-title":"Ophthalmol. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1038\/s41433-020-01303-1","article-title":"Safety of intracameral cefuroxime in pars plana vitrectomy","volume":"35","author":"Neffendorf","year":"2021","journal-title":"Eye"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1016\/j.jcrs.2011.03.032","article-title":"Macular infarction after inadvertent intracameral cefuroxime","volume":"37","author":"Qureshi","year":"2011","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/ICB.0000000000000577","article-title":"Ocular Toxicity After Inadvertent Intracameral Injection of High Dose of Cefuroxime During Cataract Surgery: A Case Series","volume":"13","author":"Osoba","year":"2019","journal-title":"Retin. Cases Brief. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"101343","DOI":"10.1016\/j.ajoc.2022.101343","article-title":"High dose cefuroxime causing retinal toxicity in a patient undergoing trabeculectomy","volume":"25","author":"Ku","year":"2022","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Niewiem, A., Broniarek, K., and Michalska-Ma\u0142ecka, K. (2025). Comparison of the Usefulness of Optical Coherence Tomography Angiography and Fluorescein Angiography in the Diagnosis of Diabetic Macular Edema. Diagnostics, 15.","DOI":"10.3390\/diagnostics15151873"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Orski, M., and Gaw\u0119cki, M. (2021). Current Management Options in Irvine\u2013Gass Syndrome: A Systemized Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194375"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.visres.2016.09.019","article-title":"Acircularity index and axis ratio of the foveal avascular zone in diabetic eyes and healthy controls measured by optical coherence tomography angiography","volume":"139","author":"Krawitz","year":"2017","journal-title":"Vis. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.ajo.2020.12.026","article-title":"Macular Microvascular Changes and Their Correlation With Peripheral Nonperfusion in Branch Retinal Vein Occlusion","volume":"225","author":"Ryu","year":"2021","journal-title":"Am. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Mirescu, A.E., Deleanu, D.G., Jurja, S., Popa-Cherecheanu, A., Balta, F., Garhofer, G., Balta, G., Cristescu, I.E., and Tofolean, I.T. (2025). Multimodal Imaging of Diabetic Retinopathy: Insights from Optical Coherence Tomography Angiography and Adaptive Optics. Diagnostics, 15.","DOI":"10.3390\/diagnostics15141732"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yu, S., Frueh, B.E., Steinmair, D., Ebneter, A., Wolf, S., Zinkernagel, M.S., and Munk, M.R. (2018). Cataract significantly influences quantitative measurements on swept-source optical coherence tomography angiography imaging. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204501"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jcrs.2018.02.014","article-title":"Changes in macular vasculature after uncomplicated phacoemulsification surgery: Optical coherence tomography angiography study","volume":"44","author":"Zhao","year":"2018","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3341\/jkos.2020.61.5.514","article-title":"Changes in the Foveal Avascular Zone after Uncomplicated Cataract Surgery Based on Optical Coherence Tomography Angiography","volume":"61","author":"Yang","year":"2020","journal-title":"J. Korean Ophthalmol. Soc."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Baldascino, A., Ripa, M., Carl\u00e0, M.M., Caporossi, T., Grieco, G., Gambini, G., De Vico, U., Raguso, G., Kilian, R., and Rizzo, C. (2022). Optical Coherence Tomography Angiography to Estimate Early Retinal Blood Flow Changes after Uncomplicated Cataract Surgery. Vision, 6.","DOI":"10.3390\/vision6030038"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4175","DOI":"10.1007\/s10792-021-01987-8","article-title":"Optical coherence tomography angiography evaluation of the effects of phacoemulsification cataract surgery on macular hemodynamics in Chinese normal eyes","volume":"41","author":"Jia","year":"2021","journal-title":"Int. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s10633-014-9465-7","article-title":"Retinal toxicity after intracameral use of a standard dose of cefuroxime during cataract surgery","volume":"130","author":"Faure","year":"2015","journal-title":"Doc. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1167\/iovs.11-8053","article-title":"Physiological and Toxicological Effects of Cefuroxime on the Albino Rabbit Retina","volume":"53","author":"Shahar","year":"2012","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1002\/glia.23727","article-title":"Glia of the human retina","volume":"68","author":"Reichenbach","year":"2020","journal-title":"Glia"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1080\/02713683.2019.1669665","article-title":"Rebuilding the Retina: Prospects for M\u00fcller Glial-mediated Self-repair","volume":"45","author":"Langhe","year":"2020","journal-title":"Curr. Eye Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Balzamino, B.O., Cacciamani, A., Dinice, L., Cecere, M., Pesci, F.R., Ripandelli, G., and Micera, A. (2024). Retinal Inflammation and Reactive M\u00fcller Cells: Neurotrophins\u2019 Release and Neuroprotective Strategies. Biology, 13.","DOI":"10.3390\/biology13121030"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Medina-Arellano, A.E., Albert-Garay, J.S., Medina-S\u00e1nchez, T., Fonseca, K.H., Ruiz-Cruz, M., and Ochoa-de la Paz, L. (2024). M\u00fcller cells and retinal angiogenesis: Critical regulators in health and disease. Front. Cell Neurosci., 18.","DOI":"10.3389\/fncel.2024.1513686"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kim, T.Y., Song, Y.Y., Il, J., Na, Y.J., Lee, Y.H., Kim, J.Y., and Lee, M.W. (2022). The impairment of the deep vascular complex in prolonged type 2 diabetes patients without clinical diabetic retinopathy. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0269182"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"9745","DOI":"10.1038\/s41598-019-46236-2","article-title":"Toxicities of and inflammatory responses to moxifloxacin, cefuroxime, and vancomycin on retinal vascular cells","volume":"9","author":"Miyake","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"9257","DOI":"10.1167\/iovs.11-8481","article-title":"Disruption of the Retinal Parafoveal Capillary Network in Type 2 Diabetes before the Onset of Diabetic Retinopathy","volume":"52","author":"Tam","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"20140195","DOI":"10.1098\/rstb.2014.0195","article-title":"Glial cell regulation of neuronal activity and blood flow in the retina by release of gliotransmitters","volume":"370","author":"Newman","year":"2015","journal-title":"Philos. Trans. R. Soc. Lond. B Biol. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1016\/j.jcrs.2010.07.007","article-title":"Early serous macular detachment after phacoemulsification surgery","volume":"36","author":"Buyukyildiz","year":"2010","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jcrs.2010.08.047","article-title":"Ocular toxicity after intracameral injection of very high doses of cefuroxime during cataract surgery","volume":"37","author":"Delyfer","year":"2011","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.jcrs.2007.05.013","article-title":"Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment","volume":"33","author":"Henderson","year":"2007","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1442-9071.2011.02638.x","article-title":"Prevalence of optical coherence tomography-diagnosed postoperative cystoid macular oedema in patients following uncomplicated phaco-emulsification cataract surgery","volume":"40","author":"Vukicevic","year":"2012","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_38","first-page":"376013","article-title":"Evaluation of cystoid macular edema using optical coherence tomography and fundus autofluorescence after uncomplicated phacoemulsification surgery","volume":"2013","author":"Sahin","year":"2013","journal-title":"J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1007\/s00417-007-0605-6","article-title":"Macular thickness after uneventful cataract surgery determined by optical coherence tomography","volume":"245","author":"Ohrloff","year":"2007","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.ophtha.2023.06.001","article-title":"Cystoid Macular Edema after Cataract Surgery in the United States: IRIS\u00ae Registry (Intelligent Research in Sight) Analysis","volume":"130","author":"Iftikhar","year":"2023","journal-title":"Ophthalmology"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Balog, S., Oluji\u0107, M., Kokot, A., Kola\u010dko, \u0160., Bosnar, D., and Predovi\u0107, J. (2025). Does Ultrasound Energy Applied During Phacoemulsification Influence the Thickness of Intraretinal Layers?. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093049"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1023\/A:1002143802926","article-title":"The role of carbonic anhydrase inhibitors in the management of macular edema","volume":"97","author":"Wolfensberger","year":"1999","journal-title":"Doc. Ophthalmol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/6\/320\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T06:17:09Z","timestamp":1781504229000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/6\/320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":42,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jpm16060320"],"URL":"https:\/\/doi.org\/10.3390\/jpm16060320","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]}}}