Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

Abstract

Purpose of review We summarize evidence-based considerations regarding the use of intracameral antibiotics during cataract surgery. Recent findings The use of intraoperative intracameral antibiotics reduced the incidence of postcataract surgery endophthalmitis 3.5-fold, with an odds ratio ranging from 0.14 to 0.19. A survey of the American Society of Cataract and Refractive Surgery showed usage of intracameral injections of antibiotics increased by 16% in the United States between 2014 and 2021. The frequency of vancomycin usage has sharply dropped to 6%, while moxifloxacin is now the dominant choice at 83% among respondents. One analysis showed that 2500 patients need to be treated with intracameral antibiotics to prevent one case of endophthalmitis. A 500 μg intracameral moxifloxacin at $22 dollars per dose is cost-effective, including for patients with posterior capsular rupture (PCR). Summary Studies substantiate the safety and efficacy of intracameral antibiotics for endophthalmitis prophylaxis. Intracameral moxifloxacin and cefuroxime are the most common choices. While vancomycin shows potential for efficacy, further studies evaluating clinical outcomes are needed. Adverse events are rare and commonly due to errors in preparation. Topical antibiotics do not provide additional prophylactic benefits to intracameral regimens. Intracameral antibiotics given alone are cost-effective.

Changes in Rates of Postprocedural Endophthalmitis and Treatments

“…It is unclear what factors may have influenced the reduced rate of postoperative infections. Intracameral antibiotics have been more commonly used, but simultaneously improved phacodynamics and operative equipment have led to shorter operative times with lower rates of capsular rupture . Thus, it remains unclear what is driving lower rates of endophthalmitis.…”