Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey

Abstract

A 2014 online survey of the American Society of Cataract and Refractive Surgery members indicated increasing use of intracameral antibiotic injection prophylaxis compared with a comparable survey from 2007. Forty-seven percent of respondents already used or planned to adopt this measure. One half of all surgeons not using intracameral prophylaxis expressed concern about the risks of noncommercially prepared antibiotic preparations. Overall, the large majority (75%) said they believe it is important to have a commercially available antibiotic approved for intracameral injection. Assuming reasonable cost, the survey indicates that commercial availability of Aprokam (cefuroxime) would increase the overall percentage of surgeons using intracameral antibiotic injection prophylaxis to nearly 84%. Although the majority used topical perioperative antibiotic prophylaxis, and gatifloxacin and moxifloxacin were still the most popular agents, there was a trend toward declining use of fourth-generation fluoroquinolones (60%, down from 81% in 2007) and greater use of topical ofloxacin and ciprofloxacin (21%, up from 9% in 2007).

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…The study has been questioned for its high rate of endophthalmitis, selection of cefuroxime due to gaps in gram-negative coverage, unknown drug concentrations in the aqueous humor, risks of hypersensitivity, the lack of a commercially available preparation, the lack of a subconjunctival cefuroxime treatment group, selection of topical levofloxacin, and methods for statistical analysis. [695][696][697] Two single-center, historicalcontrolled studies in hospitals in Spain reported decreases in acute postoperative endophthalmitis among patients undergoing cataract procedure with intracameral cefazolin added to the previous routine prophylaxis of preoperative eyelid cleansing with soap for three days 670 and povidone-iodine eye area preparation, 670,674 topical antimicrobial, and corticosteroid preparations given at the end of the procedure and postoperatively. One study found a significant decrease and a relative risk reduction of 88.7% in postoperative endophthalmitis with intracameral cefazolin.…”

A Review of Antibiotic Prophylaxis for Post-operative Endophthalmitis

“…As per the American Society of Cataract and Refractive Surgery (ASCRS) survey of 7767 members carried out in August 2014, 85% of ASCRS surgeons initiated topical antibiotics preoperatively, with 48% starting antibiotics 3 days before surgery, 32% starting antibiotics one day prior to surgery, and 20 % on the day of the surgery. 12 A retrospective analysis of the case records of 42426 eyes of all patients who had cataract surgery at Aravind Eye Hospital, Pondicherry, during January 2007 to august 2008 ISSN 0972-0200 was performed. On the day before surgery, patients received ciprofloxacin 0.3% eye drops 6 to 8 times in the operative eye.…”

“…This shows a decreasing trend of the use of antibiotics in the irrigating solution which was 48% in the 2007 ASCRS survey. 12 …”

“…[69][70][71] The 2014 ASCRS survey showed that almost 97% of the members preferred to use topical antibiotics post-operatively; with 72% of them stopping after one week and the rest continuing the topical antibiotics for several weeks post-operatively. 12 However, the evidence for their use is not very convincing. It is seen that even a 3 day treatment with topical antibiotics reduces the number of positive conjunctival cultures by only 50%.…”

The Latest Updates and Management of Endophthalmitis

“…Fluoroquinolones are the most popular class of antibiotics used due to their broad-spectrum microbial coverage, good penetration into the anterior chamber, and low adverse effect profile, with 93% of surveyed members of the American Society of Cataract and Refractive Surgery (ASCRS) favoring their use. 11 It should be noted that reports doubting the role of preoperative antibiotics before cataract surgery do exist. Rudnisky et al 5 found a 0.1% difference in the rate of endophthalmitis due to usage and nonusage of preoperative topical antibiotic.…”