Comparative Effectiveness of Antibiotic Prophylaxis in Cataract Surgery

Abstract

Purpose Intracameral injection is an effective method for preventing infection, but no controlled study has been published in the United States. Design We conducted an observational, longitudinal cohort study to examine the effect of topical and injected antibiotics on risk of endophthalmitis. Participants We identified 315 246 eligible cataract procedures in 204 515 members of Kaiser Permanente, California, 2005–2012. Methods The study used information from the membership, medical, pharmacy, and surgical records from the electronic health record. Main Outcome Measures The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of antibiotic prophylaxis (route and agent) with risk of endophthalmitis was estimated using logistic regression analysis. Results We confirmed 215 cases of endophthalmitis (0.07% or 0.7/1000). Posterior capsular rupture was associated with a 3.68-fold increased risk of endophthalmitis (CI, 1.89–7.20). Intracameral antibiotic was more effective than topical agent alone (OR, 0.58; CI, 0.38–0.91). Combining topical gatifloxacin or ofloxacin with intracameral agent was not more effective than using an intracameral agent alone (compared with intracameral only: intracameral plus topical, OR, 1.63; CI, 0.48–5.47). Compared with topical gatifloxacin, prophylaxis using topical aminoglycoside was ineffective (OR, 1.97; CI, 1.17–3.31). Conclusions Surgical complication remains a key risk factor for endophthalmitis. Intracameral antibiotic was more effective for preventing post-cataract extraction endophthalmitis than topical antibiotic alone. Topical antibiotic was not shown to add to the effectiveness of an intracameral regimen.

The occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small- and medium-scale departments of ophthalmology

“…In addition, one Spanish study showed a subsequent drop in endophthalmitis rates of approximately 15-fold (0.59% to 0.039%) after using intracameral cefuroxime (1 mg)11. A recent U.S. study also stated a dramatic reduction in infection rates (0.31% to 0.014%) after intracameral antibiotics became a standard prophylactic intervention (moxifloxacin or vancomycin was used in those cases of allergy)12. These findings lend tremendous support to the clinical benefits of intracameral antibiotic injections.…”

Clinical outcomes after injection of a compounded pharmaceutical for prophylaxis after cataract surgery

“…Single-use injections that are administered directly into the eye during surgery have been developed to meet this need. An intracameral injection of antibiotics, including cefuroxime, vancomycin, and moxifloxacin, has been shown to be well tolerated and effective at reducing the rate of postoperative endophthalmitis [11–13,14 ▪▪ ,15 ▪▪ ,16 ▪ ,17 ▪ ]. In the case of vancomycin, a retrospective analysis of more than 16 000 cases showed that an intracameral injection of 1-mg vancomycin reduced the rate of postoperative endophthalmitis more than 37-fold [12].…”

Failure Modes and Effects Analysis of bilateral same-day cataract surgery

“…8,12 An important concern in the adoption of bilateral same-day cataract surgery, however, has been the fear of bilateral vision loss from endophthalmitis and TASS. There are 4 reports in the literature, discussed in the editorial by Li et al, 20 of bilateral endophthalmitis from bilateral same-day cataract surgery, all stemming from inadequate sterilization and the lack of separating instrument trays between the 2 eyes.…”