Phacoemulsificator and Sterile Drapes Contamination during Cataract Surgery: A Microbiological Study

Balestrazzi, Angelo; Malandrini, Alex; Montagnani, Francesca; Chegoua, Ghislaine Laure Nguisseu; Ciompi, Leonardo; Zanchi, Alessandra; Tosi, Gian Marco; Martone, Gianluca; Motolese, Ilaria; Fruschelli, Mario

doi:10.5301/ejo.2011.8434

Cited by 18 publications

(12 citation statements)

References 28 publications

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“…In spite of using preoperative antibiotics and povidone-iodine and following careful sterilization and aseptic protocols, the rate of intraocular bacterial contamination has shown to be as high as 31%. [ 28 ] Injecting antibiotics intracamerally at the end of surgery is intended to kill bacterial microbes that have been introduced during the procedure. Posterior capsular rupture is one of the strongest risk factors for infectious endophthalmitis.…”

Section: Intracameral Antibiotics During Cataract Surgerymentioning

confidence: 99%

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: Intracameral Antibiotics During Cataract Surgerymentioning

confidence: 99%

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

Haripriya

2017

Indian J Ophthalmol

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“…Microbiological examinations have shown that the rate of contamination of the surgical fluids is high (up to 50%) in spite of preoperative cleaning of the conjunctiva with povidone‐iodine and preoperative use of topical antibiotic (Balestrazzi et al. ). The rate of positive samples from the anterior chamber is usually <5% (Parmar et al.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic prevention of postcataract endophthalmitis: a systematic review and meta‐analysis

Kessel

Flesner

Andresen³

et al. 2015

Acta Ophthalmologica

132

106

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ABSTRACT.Endophthalmitis is one of the most feared complications after cataract surgery. The aim of this systematic review was to evaluate the effect of intracameral and topical antibiotics on the prevention of endophthalmitis after cataract surgery. A systematic literature review in the MEDLINE, CINAHL, Cochrane Library and EMBASE databases revealed one randomized trial and 17 observational studies concerning the prophylactic effect of intracameral antibiotic administration on the rate of endophthalmitis after cataract surgery. The effect of topical antibiotics on endophthalmitis rate was reported by one randomized trial and one observational study. The quality and design of the included studies were analysed using the Cochrane risk of bias tool. The quality of the evidence was evaluated using the GRADE approach. We found high-to-moderate quality evidence for a marked reduction in the risk of endophthalmitis with the use of intracameral antibiotic administration of cefazolin, cefuroxime and moxifloxacin, whereas no effect was found with the use of topical antibiotics or intracameral vancomycin. Endophthalmitis occurred on average in one of 2855 surgeries when intracameral antibiotics were used compared to one of 485 surgeries when intracameral antibiotics were not used. The relative risk (95% CI) of endophthalmitis was reduced to 0.12 (0.08; 0.18) when intracameral antibiotics were used. The difference was highly significant (p < 0.00001). Intracameral antibiotic therapy is the best choice for preventing endophthalmitis after cataract surgery. We did not find evidence to conclude that topical antibiotic therapy prevents endophthalmitis.

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“…Regardless of the administration of antibiotics and povidone-iodine before surgery and following the careful sterilization and aseptic protocols, bacterial contamination of the anterior chamber at the end of cataract surgery occurs in 20-40% of cases. [18][19][20][21][22] Moreover, evidence shows that postoperative bacterial endophthalmitis is commonly caused by exposure to bacteria from the external eye during or after cataract surgery. The etiologies of the aqueous fluid contamination during cataract surgery are as follows: the entry of multiple instruments may carry external ocular surface flora into the anterior chamber; incision leakage caused by poor or delayed wound healing may allow the retrograde influx of external surface fluid during and after surgery; contaminated surgical instruments or implants may induce infection.…”

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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Phacoemulsificator and Sterile Drapes Contamination during Cataract Surgery: A Microbiological Study

Abstract: Evaluation of intraoperative fluids can provide evidence on sources or vehicles of postsurgical infections. Antibiotic prophylaxis and topical povidone-iodine can significantly contribute to minimize the risk of endophthalmitis.

Cited by 18 publications

References 28 publications

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

Antibiotic prevention of postcataract endophthalmitis: a systematic review and meta‐analysis

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

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