AIM: To evaluate the prophylactic usage of intracameral cefuroxime in the prevention of postoperative endophthalmitis (PE). METHODS: Phacoemulsification surgery of 6 099 patients with age-related cataract was studied retrospectively. In control group, 3 075 patients (3 075 eyes) had undergone surgery without use of intraocular antibiotics (IOA) between October 2001 and May 2004; and in study group 3 024 patients (3 024 eyes) had undergone the surgery with intracameral cefuroxime 1mg in 0.1mL between June 2004 and April 2007. Peroperative prophylaxis and operative procedures were the same in both groups. RESULTS: PE developed in 13 (0.42%) and 4 (0.13%) patients in the control and the study groups respectively [P=0.031;odds ratio= 3.20(1.04-9.84)]. PE developed 30 (3-75) days, and 25 (2-35) days after the surgeries in the two groups (P=0.35) respectively. Monomicrobial infections were observed. In the study group Aspergillus fumigatus and Pseudomonas aeruginosa were resistant to cefuroxime; however, Streptococcus pneumonia was sensitive to cefuroxime. No sign of toxicity or allergy from intracameral cefuroxime was noted.CONCLUSION: Intracameral prophylactic cefuroxime appears safe. It may provide considerable protection against bacterial PE; however, possibility of insufficient antibiotic coverage and antibiotic resistance of causative microorganism should be considered.