Overall, the Barrett Universal II formula had the lowest prediction error for the 2 IOL models studied.

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Purpose Intracameral injection is an effective method for preventing infection, but no controlled study has been published in the United States. Design We conducted an observational, longitudinal cohort study to examine the effect of topical and injected antibiotics on risk of endophthalmitis. Participants We identified 315 246 eligible cataract procedures in 204 515 members of Kaiser Permanente, California, 2005–2012. Methods The study used information from the membership, medical, pharmacy, and surgical records from the electronic health record. Main Outcome Measures The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of antibiotic prophylaxis (route and agent) with risk of endophthalmitis was estimated using logistic regression analysis. Results We confirmed 215 cases of endophthalmitis (0.07% or 0.7/1000). Posterior capsular rupture was associated with a 3.68-fold increased risk of endophthalmitis (CI, 1.89–7.20). Intracameral antibiotic was more effective than topical agent alone (OR, 0.58; CI, 0.38–0.91). Combining topical gatifloxacin or ofloxacin with intracameral agent was not more effective than using an intracameral agent alone (compared with intracameral only: intracameral plus topical, OR, 1.63; CI, 0.48–5.47). Compared with topical gatifloxacin, prophylaxis using topical aminoglycoside was ineffective (OR, 1.97; CI, 1.17–3.31). Conclusions Surgical complication remains a key risk factor for endophthalmitis. Intracameral antibiotic was more effective for preventing post-cataract extraction endophthalmitis than topical antibiotic alone. Topical antibiotic was not shown to add to the effectiveness of an intracameral regimen.

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First, the authors reported that application of the Wang-Koch adjustment for eyes with axial lengths of >25.0 mm resulted in an overcorrection of hyperopic outcomes to myopic errors (Fig 4 in the original article). We believe the authors came to this conclusion because their implementation of the Wang-Koch nomograms differed from that described in the original paper from 2011. 2 The original Wang-Koch nomograms were derived from long eye data, and serve as a way to modify existing formulae to improve outcomes in these eyes only. The original paper makes no recommendation as to whether outcomes in eyes with short and normal axial lengths should be reoptimized after applying the Wang-Koch adjustments to long eyes. However, it seems this is precisely what Melles et al did. First, they report mean numerical errors (MNEs) of zero for their Wang-Koch formulae (Tables 3 and 4 in the original article). Second, there were changes to the optimized lens constants (Table 2 in the original article) and in the prediction errors for short and normal axial length eyes when comparing unmodified formulae to their Wang-Koch counterparts (Fig 4 in the original article). We wonder whether the authors would have still found such a shift toward myopic errors in the long eyes if they had applied the Wang-Koch adjustments while keeping the optimized lens constants from the original formulae unchanged.On a related note, instead of including the Wang-Koch adjusted formulae in Fig 2 (in the original article), perhaps it would have been more illustrative to publish a separate figure comparing all of the optimized formulae to the Wang-Koch adjusted formulas for long eyes only. A small study published by our group found the Wang-Kocheadjusted Holladay1 formula produced outcomes closer to 80% within 0.5 diopter for long eyes. 3 Thus, we believe the analysis put forth by Melles et al may be under-representing how the Wang-Koch adjustments perform for long eyes.Last, the authors report poorer performance of some formulae with increasingly narrow anterior chamber depths (Fig 8 in the original article). Because the dataset was obtained from Northern California, it included a high proportion of Asian eyes, a demographic that is known to differ in this very way from their European ancestral counterparts. We wonder if this factor may have led to an under-representation of performance in the formulae. It has been established that there are differences in biometrics of eyes of different races and, therefore, formula performance can vary across geographic regions and races. 4 Perhaps a subgroup analysis stratified by race would make the results more applicable to audiences of less diverse patient populations.