Endophthalmitis prophylaxis in cataract surgery and intravitreal injection in Europe

Abstract

AbstractEndophthalmitis is a significant complication of cataract surgery and intravitreal injections (IVI), leading in severe cases to blindness. The improvements of surgical technology, techniques and procedures have significantly reduced the incidence of postoperative infections in recent years; however, it is impossible to eliminate this problem completely. The incidence of post‐cataract endophthalmitis varies among several countries from 0.03% to 0.7%. The recommendations of the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO), have set the maximum acceptable level of postoperative endophthalmitis (POE) after cataract extractions at 0.05%. Awareness about risk factors and prevention measures is necessary for ophthalmic surgeons. Surgical complications (wound leak, posterior capsule rupture, vitreous loss or zonular complications) are related with higher incidence of postoperative endophthalmitis. Elderly patients (>85 years), those with clear corneal incisions versus scleral tunnel incisions, and those without intracameral injection of cefuroxime have also a higher risk of infection.The available evidence suggests that intracameral antibiotic lowers the POE. Of the two most commonly used IC antibiotics, moxifloxacin and cefuroxime, there is no clear evidence that one is better than the other. Vancomycin is not recommended for routine ICAP because of both the risk of HORV (extremely low) and concerns regarding the use of an indispensable agent to treat multi‐drug‐resistant endophthalmitis as routine prophylaxis. Topical antibiotics may not provide an additional benefit, as has been suggested by several studies.In IVI, perioperative antibiotics cannot be considered the standard of care, as there is no evidence of prophylactic effects with regard to POE when using perioperative antibiotics. Topical administrations of 5% povidone‐iodine over at least 30 s into the conjunctival sac is recommended. Current clinical practices include minimized physician/patient talking during IVI, wearing of surgical face masks, and using face masks for nurses, technicians and physicians.