Patterns of perioperative prophylaxis for cataract surgery in Canada

Abstract

Background: The objective of this study was to document prophylactic methods used for cataract surgery in Canada. Methods: The Web-based link to a password-protected, anonymous, online survey was e-mailed or mailed, between November 2004 and January 2005, to 800 ophthalmologists practicing in Canada. Results: Of the 239 respondents (30% response rate), 216 performed cataract surgery. Phacoemulsification was preferred by 99%. Topical antibiotics, of which moxifloxacin was the most common (32%), were used preoperatively by 78%. Intraoperatively, 98% used providone-iodine antisepsis of skin, 15% used intracameral antibiotics and 11% subconjunctival antibiotics. Postoperative topical antibiotics, of which moxifloxacin was the most common (30%), were used by 97%, and 1% routinely used postoperative systemic antibiotics. Prophylactic regimen was changed after vitreous loss by 39%, of whom 68% added systemic antibiotics. Reported mean rate of postoperative endophthalmitis occurring within the previous year was 0.088%. Community practicing ophthalmologists were more likely to use preoperative topical antibiotics ( p = 0.0016, χ 2). As case volume increased, surgeons were more likely to use intracameral antibiotics ( p = 0.0185, exact Mantel-Haenszel χ 2 test) and postoperative topical antibiotics ( p = 0.0044, exact Mantel-Haenszel χ 2 test), and less likely to use subconjunctival antibiotics ( p = 0.0011, exact Mantel-Haenszel χ 2). As time in practice decreased, surgeons were more likely to use postoperative topical antibiotics ( p = 0.0319, exact Mantel-Haenszel χ 2 test). Provincial region was associated with preoperative topical antibiotic use ( p = 0.0076, Fisher's exact test), intracameral antibiotic use ( p = 0.0314, Fisher's exact test), and subconjunctival antibiotic use ( p = 0.0373, Fisher's exact test). There was no association between reported rate of postoperative endophthalmitis and any form of perioperative antibiotic use. Interpretation: Prophylactic methods commonly used for cataract surgery in Canada include providone-iodine antisepsis and perioperative topical antibiotics. Intracameral and subconjunctival antibiotics are currently not common prophylactic methods. Systemic antibiotics are used prophylactically by a subset of ophthalmologists for cases complicated by vitreous loss.