Endophthalmitis after cataract surgery

Garg, Prashant; Roy, Aravind; Sharma, Savitri

doi:10.1097/icu.0000000000000326

Cited by 64 publications

(30 citation statements)

References 38 publications

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“…Numerous recent review articles have discussed in detail the evidence towards and against routine use of IC antibiotic prophylaxis. [ 57 58 59 60 ] We agree with the 2016 American Academy of Ophthalmology Cataract Preferred Practice Pattern's assessment of the published literature that “there is mounting evidence that injecting IC antibiotics as a bolus at the conclusion of surgery is an efficacious method of endophthalmitis prophylaxis.”[ 61 ] There is much stronger evidence supporting the efficacy of IC antibiotic injection than for topical administration for endophthalmitis prophylaxis.…”

Section: Discussionmentioning

confidence: 72%

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

Haripriya

2017

Indian J Ophthalmol

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Various protocols are being followed for endophthalmitis prophylaxis in cataract surgery, and this subject continues to be a matter of debate. We summarize the most recent evidence-based studies on this topic with additional stress on intracameral (IC) antibiotic prophylaxis. Here, we discuss several large, international clinical studies which discuss the efficacy, adoption, safety, cost, and newer trends in antibiotic prophylaxis. Majority of these studies report a significant reduction in endophthalmitis rates with IC antibiotic prophylaxis. Efficacy data have been reported for IC cefuroxime, vancomycin, and moxifloxacin. Surgeons are now looking for alternatives to vancomycin for IC prophylaxis because of its association with the rare but sight-threatening complication of hemorrhagic occlusive retinal vasculitis. A recent large clinical study shows convincing efficacy with IC moxifloxacin prophylaxis. Two large studies have also reported significant endophthalmitis reduction following use of IC antibiotic prophylaxis, in eyes with posterior capsule tear which are at highest risk for infection. Except for one randomized controlled trial, there is a lack of prospective data on this subject; however, considering the complexity of performing such studies, surgeons have to rely on the mounting evidence from other recent big data studies. Availability of approved intraocular antibiotic formulations will see a much higher adoption in the future.

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Section: Discussionmentioning

confidence: 72%

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

Haripriya

2017

Indian J Ophthalmol

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“…Endophthalmitis is associated with a variety of factors, including the species and quantity of bacteria entering the anterior chamber, operative technique, sanitary condition, perioperative aseptic measures, and postoperative patient education. 43 Studies have reported intracameral antibiotics present no benefits when topical antibiotics are used, 3 or vice versa. 44 Lack of consensus makes it unlikely to conclusively define the optimal endophthalmitis prophylaxis techniques via additional clinical trials.…”

Section: Discussionmentioning

confidence: 99%

<p>Intraoperative Cefuroxime Irrigation Prophylaxis for Acute-Onset Endophthalmitis After Phacoemulsification Surgery</p>

Ma¹,

Xie²,

Huang³

2020

IDR

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Purpose: Acute-onset postoperative endophthalmitis usually compromises the visual function and anatomical integrity of the eye. The aim of this study was to evaluate the efficacy of intraoperative cefuroxime use in irrigating solution on prevention of acute-onset endophthalmitis after phacoemulsification. Methods: This retrospective, comparative, interventional cohort study included patients who underwent phacoemulsification between January 1, 2012, and December 31, 2019. Under a uniform perioperative protocol, the patients who had surgery from January 1, 2012, to December 31, 2014, received irrigating infusion fluid containing balanced salt solution (BSS) only (group 1), and those from January 1, 2015, to December 31, 2019, received BSS with cefuroxime (1500 μg/mL) during surgery (group 2). All eyes were evaluated postoperatively, and the eyes suspected to have endophthalmitis were assessed and treated by a consultation team. The rates of postoperative endophthalmitis in these two groups were calculated. Results: A total of 61,299 eyes were included over the eight years. Among these eyes, 11 in group 1 (0.07% of 15,948 eyes) and 5 in group 2 (0.01% of 45,351 eyes) developed endophthalmitis, and the difference was significant (P < 0.01). Five among 16 patients (31.25%) with endophthalmitis were positive in bacterial culture. The positive rate of bacterial culture was not significantly different between group 1 (4/11) and group 2 (1/5) (P > 0.05). No adverse events related to the irrigation of cefuroxime were found. Conclusion: Intraoperative cefuroxime irrigation (1500 μg/mL) could decrease the rate of postoperative endophthalmitis after phacoemulsification by 7-fold. This study provides evidence that intraoperative irrigation with cefuroxime is effective as an antibiotic prophylaxis for endophthalmitis.

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“…Some ophthalmologists use pre- or postoperative topical antibiotics. 12 The drug itself, or other components of the drug solution, could potentially induce toxic side effects to the ocular surface cells. As discussed in more detail by Mantelli et al, 13 the detrimental role of topical therapies on the ocular surface and the thin border between their therapeutic and toxic effects may arise from both the preservatives and other components in the preparations depending on dose, frequency, and duration of treatment.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravitreal injections on dry eye, and proposed management strategies

Laude¹,

Lim²,

Srinagesh³

et al. 2017

OPTH

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Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents has become a commonly used treatment method for a number of ophthalmic conditions, including age-related macular degeneration. Although anti-VEGF therapy has shown promising results for many patients, there are several aspects of its application that have not been thoroughly investigated. One of these is the development and/or escalation of concurrent dry eye syndrome. Many patients undergoing treatment are already predisposed to dry eye disease due to their age and overall ocular health. As dry eye can have a substantial impact on quality of life, it has become increasingly apparent that the clinical signs and symptoms should be closely monitored and aggressively managed. This will allow for the optimization of patient comfort and visual potential. Here, we discuss the reasons why dry eye may develop during the course of repeated ocular anti-VEGF therapy, highlighting the key concerns about current practices and proposing possible solutions to improve the outcome for the patients.

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Endophthalmitis after cataract surgery

Cited by 64 publications

References 38 publications

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

<p>Intraoperative Cefuroxime Irrigation Prophylaxis for Acute-Onset Endophthalmitis After Phacoemulsification Surgery</p>

The effect of intravitreal injections on dry eye, and proposed management strategies

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