A Review of Antibiotic Prophylaxis for Post-operative Endophthalmitis

Apurva Goray

doi:10.7869/djo.162

Abstract

The purpose of this review is to summarise all available evidence regarding antibiotic prophylaxis for post cataract surgery endophthalmitis as some prophylactic measures add significantly to the cost of surgery, are routinely used and yet their benefit to cataract patients has not been proven. Use of Povidone Iodine before starting the surgery is one of the most effective means of reducing the incidence of postoperative endophthalmitis. Intracameral cefuroxime is another important measure advocated by many studies. Intracameral moxifloxacin may be considered as an alternative to cefuroxime. Although pre and post-operative systemic or topical antibiotics, subconjunctival antibiotics and antibiotics in the irrigating solution have not been proven to decrease post-operative endophthalmitis, they have not been shown to be detrimental and hence surgeons may consider their use according to personal preferences and a costbenefit analysis of their healthcare system.

Highlights

Cataract extraction is by a wide margin the most common intraocular surgery performed worldwide, with more than 5.1 million patients undergoing cataract surgery annually in India alone.[1]
Data from the European Society of Cataract and Refractive Surgeons (ESCRS) group illustrated that the placebo group demonstrated an increase in the risk of laboratory confirmed endophthalmitis compared to the group receiving two drops 0.5% levofloxacin 1 hour prior to cataract surgery
Moxifloxacin is the only drug which has been associated with reduction in post-operative endophthalmitis but conclusive evidence is still lacking

Summary

Introduction

Cataract extraction is by a wide margin the most common intraocular surgery performed worldwide, with more than 5.1 million patients undergoing cataract surgery annually in India alone.[1]. With the use of only topical fluoroquinolones, without intracameral or subconjunctival antibiotic agents, the overall 0.09% incidence of presumed infectious endophthalmitis was comparable to that in the prospective multicentre multinational ESCRS study subgroup receiving intracameral antibiotics (0.075%).[1,13] Ta et al concluded that a 3 day pre-treatment with topical ofloxacin reduced bacterial conjunctival flora as compared to treatment starting 1 hour prior to surgery.[14] Data from the European Society of Cataract and Refractive Surgeons (ESCRS) group illustrated that the placebo group demonstrated an increase in the risk of laboratory confirmed endophthalmitis compared to the group receiving two drops 0.5% levofloxacin 1 hour prior to cataract surgery This finding was not statistically significant.[11,15] In the ESCRS postoperative endophthalmitis study designed in 2002, levofloxacin was selected as the antibiotic for use in the topical preoperative prophylaxis arm for all patients and for prevention of postoperative infection. The use of oral or systemic antibiotics as prophylaxis for endophthalmitis is controversial and not recommended.[28]

Objectives

Findings

Conclusion