European Society Of Cataract And Refractive Surgeons Research Articles

Prospective evaluation of the ESCRS online calculator for calculation of a multifocal intraocular lens.

To evaluate a recently introduced ESCRS online calculator for intraocular lens (IOL) calculation of a multifocal IOL in refractive lens exchange and cataract surgery in a prospective setting. Department of Ophthalmology, Goethe University Frankfurt, Germany. Prospective, consecutive case series. We included eyes that received lens extraction and multifocal IOL implantation. We compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of the online calculator provided by the European Society of Cataract and Refractive Surgeons (ESCRS), and number of eyes within ±0.5, ±1.0, ±2.0 diopters (D) of target refraction. Additionally, the SRK/T formula was included for comparison as well. Postoperative spherical equivalent was measured at 3 months. Only one eye per patient was included. Eighty-eight eyes from 88 patients with mean age of 62 years ± 9.5 were included. The MedAE was low for all formulas and ranged from 0.26D (Kane), Hill-RBF (0.27D), Hoffer QST (0.27D), Barrett (0.28D), EVO (0.29D), Cooke K6 (0.27D), 0.30D (Pearl DGS) to 0.31D (SRK/T). No statistically significant difference was found (p = 0.627). Considering the number of eyes within ±0.5D of the calculated refraction the best performing was again the Hill-RBF (84%, 74 eyes), again followed by Kane (71, 81%), EVO, Pearl DGS, Hoffer QST, Barrett (each 80%, 70 eyes),Cooke K6 (78%, 69 eyes), and SRK/T (74%). Again, no statistically significant difference was found (p = 0.39). Using recently introduced ESCRS online IOL calculator in multifocal intraocular lenses leads to a high number of eyes reaching target refraction and low prediction errors. All formulas performed similar well. However, Hill-RBF showed the highest number of eyes within ±0.5D, but no significance was found regarding this.

Hybrid Ophthalmology Conferences: Paradigm Shift in 2022

Introduction: It has been almost a year since our journal talked about ophthalmology conferences under the COVID-19 era [1]. With the COVID-19 pandemic continuing throughout 2022, scholars and academics are finding their ways out for scientific exchange of knowledge and research advances [2]. Virtual conferences were mostly turning into hybrid form to cater for delegates from around the world both physically and electronically [3]. Going through the Asia-Pacific Academy of Ophthalmology (APAO) official website’s meeting calendar page, recent international conferences are 40th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) held on 16-20 September 2022; American Academy of Ophthalmology (AAO) 2022 held on 30 September to 3 October 2022, and 15th Asia-Pacific Vitreo-Retina Society (APVRS) Congress held on 18-20 November 2022. These are all conducted in hybrid formats. There are few similarities, but also differences, across these hybrid conferences.

Immediate sequential bilateral cataract surgery: The rationale, implementation, and beliefs of ophthalmic surgeons across Europe

To assess the attitudes and beliefs held toward immediate sequential bilateral cataract surgery (ISBCS), including estimating the incidence of European Society of Cataract and Refractive Surgeons (ESCRS) members currently performing ISBCS, exploring the barriers of ISBCS implementation, and assessing the relevance of these findings to practice in the United Kingdom. European consultant members of the ESCRS. Survey-based questionnaire. The survey was sent and collected electronically. An initial screening question directed the rest of the survey; participants were asked to rate the importance of several factors with regard to performing ISBCS. Free text options were also available. Descriptive analysis was performed. Of the 2200 recipients, 303 (13.7%) responded, of which 247 were eligible for analysis. Of the 247 eligible respondents, 166 (67.2%) reported performing ISBCS, 71 (28.7%) said they did not perform ISBCS, and 10 (4.0%) said they had previously done so but have since stopped. Of those who were currently practicing ISBCS, the three most important factors to consider were all directly related to infection risk. Of those who did not perform ISBCS, the most important reasons for not performing the surgery were a risk for endophthalmitis (69.0%) and the medicolegal issues should ISBCS go wrong (57.8%). The most common reason for stopping ISBCS was that the respondent no longer believed in the benefit of ISBCS (n=4). The survey reflects ophthalmologists' concerns regarding infection and medicolegal risks; however, reports of bilateral endophthalmitis are extremely rare when the correct recommendations are followed. The findings from this survey could be used to inform service provision of ISBCS in the U.K., taking into consideration the voices of colleagues overseas.

N-acetylcarnosine (NAC) drops for age-related cataract.

Cataract is the leading cause of world blindness. The only available treatment for cataract is surgery. Surgery requires highly-trained individuals with expensive operating facilities. Where these are not available, patients go untreated. A form of treatment that did not involve surgery would be a useful alternative for people with symptomatic cataract who are unable or unwilling to undergo surgery. If an eye drop existed that could reverse or even prevent progression of cataract, then this would be a useful additional treatment option.Cataract tends to result from oxidative stress. The protein, L-carnosine, is known to have an antioxidant effect on the cataractous lens, so biochemically there is sound logic for exploring L-carnosine as an agent to reverse or even prevent progression of cataract. When applied as an eye drop, L-carnosine cannot penetrate the eye. However, when applied to the surface of the eye, N-acetylcarnosine (NAC) penetrates the cornea into the front chamber of the eye (near to where the cataract is), where it is metabolised into L-carnosine. Hence, it is possible that use of NAC eye drops may reverse or even prevent progression of cataract, thereby improving vision and quality of life. To assess the effectiveness of NAC drops to prevent or reverse the progression of cataract. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), Allied and Complementary Medicine Database (AMED) (January 1985 to June 2016), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 28 June 2016. We handsearched the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS) meetings from 2005 until September 2015. We planned to include randomized or quasi-randomised controlled trials where NAC was compared to control in people with age-related cataract. We used standard methodological procedures expected by Cochrane. We identified two potentially eligible studies from Russia and the United States. One study was split into two arms: the first arm ran for six months, with two-monthly follow-up; the second arm ran for two years with six-monthly follow-up. The other study ran for four months with a data collection point at the start and end of the study only. A total of 114 people were enrolled in these studies. The ages ranged from 55 to 80 years.We were unable to obtain sufficient information to reliably determine how both these studies were designed and conducted. We have contacted the author of these studies, but have not yet received a reply. Therefore, these studies are assigned as 'awaiting classification' in the review until sufficient information can be obtained from the authors. There is currently no convincing evidence that NAC reverses cataract, nor prevents progression of cataract (defined as a change in cataract appearance either for the better or for the worse). Future studies should be randomized, double-masked, placebo-controlled trials with standardised quality of life outcomes and validated outcome measures in terms of visual acuity, contrast sensitivity and glare, and large enough to detect adverse effects.

The Importance of Diagnosing Ectatic Corneal Disease

Ectatic corneal disease (ECD) or corneal ectasia is a group of progressive eye disorders characterised by thinning and bulging of the cornea, and can result in moderate to severe impairment of vision. Recent advances in corneal imaging systems allow for the detection of mild or subclinical stages of the disease, which is fundamental in the face of novel strategies for minimising progressive ectasia after laser vision correction procedures, such as LASIK and SMILE. At the European Society of Cataract and Refractive Surgeons (ESCRS) Annual Meeting, in Lisbon, in October 2017, Renato Ambrósio Jr, Medical Director of the Instituto de Otho and Refracta-RIO, Rio de Janeiro, Brazil, discussed the importance of diagnosing ECD and how advances in corneal imaging technologies can enhance diagnosis.

Reliability and reproducibility of the German version of the European Society of Cataract and Refractive Surgeons reading charts

To create a validated, standardized, logarithmic European Society of Cataract and Refractive Surgeons (ESCRS) reading chart in German and to use this reading chart as a template for comparable reading charts in other languages. Hanusch Hospital, Vienna, and Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria. Prospective multicenter validation study. Thirty-nine short standardized German sentences were developed and tested on healthy volunteers and pseudophakic patients. On the first visit, corrected distance visual acuity was assessed in each eye using autorefraction (KR8000) and subjective refraction using Early Treatment Diabetic Retinopathy Study charts at 4 m. Reading speed, when reading the new ESCRS reading charts, was tested under photopic conditions (85 to 100 candelas/m(2)) and high contrast (≥95% Michelson contrast). The study assessed 120 subjects. Sixty subjects were young healthy volunteers and 60 were pseudophakic patients. Reliability of the sentences was tested using Cronbach's α and was found to be high (α = 0.994). Furthermore, reproducibility was high in most cases and the absolute mean difference between the first measurement and second measurement for all sentences was 0.56 seconds ± 0.07 (SD) (range 0.43 to 0.72 seconds). The German version of the ESCRS reading charts, a standardized logarithmic and validated reading test, was reliable in healthy volunteers as well as in pseudophakic patients. No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of stability of lens rotation and lens wear comfort of toric soft contact lenses in Singapore

s / Contact Lens & Anterior Eye 38 (2015) e13–e46 e45 Conclusions: CRT and RNFLmeasurements in both groupswere slightly higher after focus adjustment in the system software. In group II (high myopia) all measurements were decreased in comparison to group I (medium myopia). Both methods of refractive error correction (within the examined range) enabled good quality images and objective morphometric analysis. Soft contact lens application may be an alternative correction of high myopia in case of refractive error exceeding focus adjustment range. Ilona Piotrowiak was born in 1983 in Bydgoszcz, Poland. Ilona graduated from the Nicolas Copernicus University, Faculty of Medicine in2008and started a residency inophthalmology in2009. Illona is an author and co-author ofmany international articles and haspresentedpapers onnumerous occasions at various congresses. Illona’s professional interests include anterior segment of the eye, diagnostic and treatment. Illona is a Member of the Polish Society of Ophthalmology (PTO) and the European Society of Cataract and Refractive Surgeons (ESCRS). http://dx.doi.org/10.1016/j.clae.2014.11.078

Postcataract Surgery Endophthalmitis after Introduction of the ESCRS Protocol: A 5-year Study

To present the results of a retrospective comparative unicentric institutional study of the incidence of postcataract surgery endophthalmitis before and after the introduction of the European Society of Cataract and Refractive Surgeons (ESCRS) protocol in 2007 in our department. This study included 15,689 eyes of patients undergoing cataract surgery between 2005 and 2011. Surgeries were performed by 9 different surgeons. After June 2007, the ESCRS protocol was introduced, and all patients underwent intracameral injection of 1 mg of cefuroxime (10 mg/mL) at the end of cataract surgery. Cefuroxime was prepared prior to surgery in the operating room. All patients were observed between 6 weeks and 3 months after surgery. Between January 2005 and June 2007, before the introduction of the ESCRS protocol in our department, 2299 patients underwent cataract surgery and there were 6 cases of postoperative endophthalmitis (0.26%). After the introduction of the protocol, 13,390 surgeries were performed and there were no cases of endophthalmitis. Postoperative endophthalmitis is one of the most devastating cataract surgery complications. Our results provide strong evidence of the utility of cefuroxime as prophylaxis of endophthalmitis after cataract surgery.

European registry for quality improvement in cataract surgery.

A project aimed at creating a multi-national database for cataract and refractive surgery was initiated in 2008. The database was intended for learning and clinical improvement, not supervision. The project was co-funded by the European Union, under the Executive Agency for Health and Consumers and the European Society of Cataract and Refractive Surgeons (ESCRS) and supported by 11 national societies for cataract and refractive surgery. The purpose of this article is to describe the setup of the database and the ensuing achievements within cataract surgery after four years. A web-based system was created for input and output of data, with a software interface to two databases, one for cataract surgery and one for refractive surgery. Data can be put in either manually through web forms or by transfer of data from existing national registries or large electronic medical record systems. Output of reports from the system or export of one's own data is available on the web. The data are anonymous to all users, with the sole exception that reporting surgeons and clinics have access to their own data. The system does not include any patient identification. After four years, data from 16 countries have been entered into the system, including reports of more than 900,000 cataract extractions. The database has been used by individual clinics for benchmarking and clinical improvement work, and has also served as the basis for new clinical guidelines for cataract surgery. The ESCRS has guaranteed the sustainability of the database after the project period. A European quality registry with data input from surgeons and clinics in 16 European countries has been established. Close to one million surgeries have been entered into the system during the first four years. Evidence-based guidelines have been published based on data in the registry. The system is used for benchmarking by both experienced surgeons and trainees.

The work and influence of the Raghudeep Eye Clinic, Ahmedabad, India

Interview by Tanya Stezhka, Commissioning EditorDr Abhay R Vasavada completed his FRCS in 1980 from the Royal College of Surgeons, England, and started Raghudeep Eye Clinic, as a cataract speciality clinic in 1984 in Ahmedabad, India. He has been instrumental in positioning cataract management as a subspeciality, and in raising the bar for management outcomes, be it the popularization of intraocular lens (IOLs) or establishing phacoemulsification as a standard of care, in the entire Asia-Pacific region. His expertise extends to managing the most complex and challenging cataracts in adults and children. He has made important contributions to the understanding and practise of cataract surgery like: emphasizing the role of balancing phaco fluidics (step-down technique); innovating a versatile chop technique (step-by-step chop in situ and lateral separation); defining paradigms for challenging cases like dense cataracts, small pupils and subluxated cataracts; devising the ‘inside-out delineation’ technique for posterior polar cataracts; recognizing the entity of ‘cortico-capsular adhesions’; and many more. He firmly believes that quality care should extend to all strata of society. He runs a center in a small town, Dholka, where the highest quality of eye care is provided to lesser privileged sections of society at nominal charges. Research is his passion right from his early days. He set up the Iladevi Cataract & IOL Research Center (ICIRC), a center providing basic research facility in 1991. Today, ICIRC is a Government of India recognized research laboratory dedicated to basic research and translational research pertaining to commonly prevalent eye conditions. He is a distinguished member of different ophthalmic bodies, including the International Council of Ophthalmology (ICO), American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), European Society of Cataract and Refractive Surgeons (ESCRS), Academia Ophthalmologica Internationalis (AOI), Asia Pacific Academy of Ophthalmology (APAO), Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS) and others.His contribution to ophthalmology has been recognized worldwide. Some of the most prestigious awards he has received include the Binkhorst Medal lecture by the ASCRS.

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.

Endophthalmitis is a severe inflammation of the anterior and/or posterior chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection. The objective of this review was to evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 October 2012. We also searched for additional studies that cited any included trials using the Science Citation Index. We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. Trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic) or postoperative antibiotic prophylaxis for acute endophthalmitis were included. We did not include studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine, nor did we include studies that evaluated antibiotics for treating acute endophthalmitis after cataract surgery. Two review authors independently reviewed abstracts and full-text articles for eligibility, assessed the risk of bias for each included study, and abstracted data. Four studies met the inclusion criteria for this review, including 100,876 adults and 131 endophthalmitis cases. While the sample size is very large, the heterogeneity of the study designs and modes of antibiotic delivery made it impossible to conduct a formal meta-analysis. Interventions investigated in the studies included the utility of adding vancomycin and gentamycin to the irrigating solution compared with standard balanced saline solution irrigation alone, use of intracameral cefuroxime and/or topical levofloxacin perioperatively, periocular penicillin injections and topical chloramphenicol-sulphadimidine drops compared with topical antibiotics alone,and mode of antibiotic delivery (subconjunctival versus retrobulbar injections). Two studies with adequate sample sizes to evaluate a rare outcome found reduced risk of endophthalmitis with antibiotic injections during surgery compared with topical antibiotics alone: risk ratio (RR) 0.33, 95% confidence interval (CI) 0.12 to 0.92 (periocular penicillin versus topical chloramphenicol-sulphadimidine) and RR 0.21, 95% CI 0.06 to 0.74 (intracameral cefuroxime versus topical levofloxacin). Another study found no significant difference in endophthalmitis when comparing subconjunctival versus retrobulbar antibiotic injections (RR 0.85, 95% CI 0.55 to 1.32). The fourth study which compared irrigation with balanced salt solution (BSS) alone versus BSS with antibiotics was not sufficiently powered to detect differences in endophthalmitis between groups. The risk of bias among studies was low to unclear due to information not being reported. Multiple measures for preventing endophthalmitis following cataract surgery have been studied. One of the included studies, the ESCRS (European Society of Cataract and Refractive Surgeons) study, was performed using contemporary surgical technique and employed cefuroxime, an antibiotic commonly used in many parts of the world.Clinical trials with rare outcomes require very large sample sizes and are quite costly to conduct; thus, it is unlikely that additional clinical trials will be conducted to evaluate currently available prophylaxis. Practitioners should rely on current evidence to make informed decisions regarding prophylaxis choices.

Survey of practice preference pattern in antibiotic prophylaxis against endophthalmitis after cataract surgery in Singapore

To determine practice preference of prophylaxis against post-cataract surgery endophthalmitis in Singapore. Prospective nationwide survey of all registered ophthalmologists through telephone, e-mail or postal questionnaires. A response rate of 76.6% was obtained from 121 out of 158 eligible ophthalmologists. Awareness of the recommendations made by the European Society of Cataract and refractive surgeons (ESCRS) endophthalmitis study was noticed in 98 (81.0%) respondents. Out of the 121 respondents, 85 (70.2%) do not use intracameral antibiotic prophylaxis. Of the 36 respondents using intracameral antibiotics, 34 (94.4%) used cefazolin. The reasons cited for not adopting intracameral antibiotic prophylaxis included financial costs, the relatively low risk of endophthalmitis after cataract surgery, the burden of dilution and the fear of toxic anterior segment syndrome. More than half (65, 53.7%) of respondents would use intracameral antibiotic prophylaxis if it were available commercially. The most commonly practiced prophylaxis (94, 77.7%) was preoperative topical antibiotics. The majority of ophthalmologists in Singapore have not adopted the use of intracameral antibiotics, with most preferring the use of pre- and postoperative prophylactic topical antibiotics, despite knowledge of the ESCRS endophthalmitis study.

Intracameral antibiotics for the prevention of endophthalmitis in cataract surgery

Aim: To determine if there is enough evidence to support the use of intracameral antibiotics for the prevention of endophthalmitis post cataract surgery. Method: A systemic review of English language articles was conducted by performing a broad search using Medline/ProQuest, Science Direct, the Cochrane Library and Embase. The search was restricted to articles published between January 2005 and October 2010. The terms endophthalmitis and intracameral antibiotics were used to initiate the search but the term cataract was used for further exclusion. The population base incorporated adult patients undergoing cataract surgery. Limitations include one author as a reviewer of the titles resulting from the literature searches. A team review would give a more robust methodological quality. Results: Of the 493 results that were identified in the literature search 451 citations were excluded after screening titles and abstracts. Forty two publications were included for this review and were identified as being relevant after scrutiny. Publications showing retrospective data far exceeded the number of prospective case controlled studies negatively affecting the number of high quality articles reviewed. A randomized controlled study released by the European Society of Cataract and Refractive Surgeons (ESCRS) published results in 2006 showing a near _fivefold decrease in the rates of post-operative endophthalmitis with the use of intracameral cefuroxime. This study was discontinued due to ethical considerations. The study observed a clear benefit from the use of intracameral cefuroxime. Moxifloxacin has not been truly evaluated and has a potential for bacterial resistance. Topical antibiotics are unreliable relying on patient compliance and requiring frequent administration. From this review an effective solution for endophthalmitis prevention remains unclear. Conclusion: Intracameral cefuroxime administered at the time of surgery seems to work well for reducing the incidence of post-operative endophthalmitis as it is a broad spectrum and cost-effective antibiotic. The major barrier to its clinical use is the lack of a commercial preparation which increases the threat of dilution errors, which is known to be toxic to human endothelial cells.

News and Meetings in Ophthalmology

January 18–23, 2009, Maui, HI, USA Hawaiian Eye 2009http://www.osnhawaiianeye.com February 6–8, 2009, Rome, Italy ESCRS Winter Refractive Meetinghttp://www.escrs.org March TBD, 2009, San Diego, CA, USA American Glaucoma Society Annual Meetinghttp://www.glaucomaweb.org/ April 4–8, 2009, San Francisco, CA, USA ASCRS/ASOA Symposium and Congresshttp://www.ascrs.org April 16–18, 2009, Geneva, Switzerland 4th International Congress on Glaucoma Surgery (ICGS)http://www.oic.it/icgs2009 April 17–21, 2009, San Francisco, CA, USA AAPOS™ 35th Annual Meetinghttp://www.aapos.org May 3–7, 2009, Fort Lauderdale, FL, USA ARVO Annual Meeting 2009http://www.arvo.org May 14 – 17, 2009, Nice, France 9th Congress of European Society of Retina Specialists (EURETINA)http://www.euretina.org June 12, 2009, Bordeaux, France 3rd International Conference on Femtosecond Lasers in OphthalmologyE-mail: toubould@gmail.com June 12–13, 2009, Amsterdam, the Netherlands The 2009 European Professors in Ophthalmology (EUPO 2009) course on cornea, conjunctiva and refractive surgeryhttp://www.eupo.eu June 13–16, 2009, Amsterdam, the Netherlands SOE 2009, 17th Congress of the European Society of Ophthalmologyhttp://www.soe2009.org June 18–21, 2009, Nürnberg, Germany Congress of Ophthalmic Surgeonshttp://www.doc-nuernberg.de July 8–11, 2009, Boston, MA, USA World Glaucoma Congresshttp://www.worldglaucoma.org September 12–16, 2009, Barcelona, Spain Congress of the European Society of Cataract and Refractive Surgeons (ESCRS)http://www.escrs.org September 12–16, 2009, Istanbul, Turkey 22nd ECNP CongressE-mail: ecnp2006@congrex.nl September 30–October 3, 2009, Portoroz, Slovenia European Association for Vision and Eye Research (EVER)http://www.ever.be October 24–27, 2009, San Francisco, CA, USA Annual Meeting of the American Academy of Ophthalmologyhttp://www.aao.org December 3–6, 2009, Rome, Italy The 8th International Symposium on Ocular Pharmacology and Therapeuticals (ISOPT)http://www.isopt2009.com

Prophylaxe der postoperativen infektiösen Endophthalmitis durch intrakamerale Cefuroximgabe – auf dem Weg zum Therapiestandard?

Several studies investigating the antibiotic prophylaxis of acute postoperative endophthalmitis provide very different results concerning the incidence and prophylaxis of this very severe complication of cataract surgery. For a long time the preoperative use of povidione-iodine had been the only procedure with overall acceptance and proven benefit. Following findings in Sweden that supported the advantages of the use of intracameral cefuroxime, the European Society of Cataract and Refractive Surgeons (ESCRS) performed a study to confirm the Swedish results and to lead to a revision of ESCRS guidelines. In a randomised, partially masked and placebo-controlled study 16,211 patients undergoing phacoemulsification cataract surgery were included. 25 ophthalmological units in 9 European countries took part in this study. The study consists of a 2 x 2 factorial design, dividing patients into 4 treatment groups. Two out of the 4 groups were treated with 1 mg intracameral cefuroxime (in 0.1 mL isotonic NaCl solution). In parallel, two groups (one treated with cefuroxime, one untreated) received topical levofloxacin 0.5% in a standard regimen. If clinical signs like pain or loss of vision indicated a postoperative endophthalmitis, suspicious results were confirmed by culture, Gram stain and PCR. In a follow-on study, Sundelin (Sweden) and colleagues included 30 patients who received topically-applied levofloxacin 0.5% following the ESCRS dosing scheme, in addition to intracameral administration of cefuroxime. Aqueous humour samples were taken at the end of surgery and at a second time point postoperatively. The levofloxacin concentration was measured by HPLC. The median maximal concentration (Cmax) was compared with the MIC90-values of relevant bacterial isolates. 29 patients developed a postoperative endophthalmitis, of whom 20 were classified as having a proven infectious cause. The absence of a prophylactic intracameral cefuroxime administration at 1 mg in 0.1 mL isotonic NaCl was associated with a 4.92-fold increase in the risk of postoperative endophthalmitis (95% CI 1.87-12.9). A clear corneal incision (CCI) or the use of silicon based IOL optic material accounted as additional risk factors for postoperative endophthalmitis. While the use of CCI was associated with a 5.88-fold higher risk of infection compared to STI (scleral tunnel incision), the implantation of silicon based IOL was associated with a 3.13-fold higher risk. Intraoperative complications were also associated with a higher risk of postoperative endophthalmitis (4.95-fold higher risk). Intracameral injection of cefuroxime reduces the risk of postoperative infectious endophthalmitis following phacoemulsification cataract surgery. Additional risk factors are the use of CCI and silicon based IOL implants.

Prophylaxie des endophtalmies après chirurgie de cataracte

In this review, we report the most recent findings on antibiotic prophylaxis during cataract surgery. The ESCRS (European Society of Cataract and Refractive Surgeons) has published the results of a study using a cefuroxime injection in the anterior chamber at the end of cataract surgery. It was found that this antibiotic injection reduced the rate of postoperative endophthalmitis fivefold. Based on the analysis of the available literature, we summarize the relevant information consistent with evidence-based medicine. Finally, we provide additional practical tips on antibiotic prophylaxis such as asepsis and antisepsis to decrease postcataract endophthalmitis.

The High Communication Wetlab: A Unique Innovation in Teaching Ophthalmic Surgery

The continuous development of new surgical techniques and the need for efficient surgical education of ophthalmologists have inspired the development of the High Communication Wetlab (HCW). The HCW is a highly efficient, audio-visual teaching, learning and practising facility which is part of the European Comett II Project on Innovative Ophthalmic Surgery (INOS), also supported by the European Society of Cataract and Refractive Surgeons (ESCRS). The International Institute for Experimental Surgery and its scientific consultant board consisting of leading ophthalmic surgeons are the project leaders.