Antibiotic prophylaxis practice patterns for cataract surgery in India – Results from an online survey

Abstract

Purpose:The aim of this study is to assess the current antibiotic prophylaxis practice patterns for cataract surgery in India.Methods:This was a questionnaire-based E-survey carried out at a tertiary eye care center in India. An E-mail invitation to complete an online 20 point questionnaire survey was sent to all members of the All India Ophthalmological Society with valid E-mail addresses using a digital E-mail service. Duplicate entries were prevented.Results:Out of 1228 total respondents (8.2%) who completed the survey 38% reported using routine intracameral (IC) antibiotic prophylaxis. Another 7% place antibiotics in the irrigating solution. Of those using IC antibiotic prophylaxis, 91% adopted this practice within the past 2 years; 92% are using moxifloxacin with 56% using a commercially available moxifloxacin formulation. Those predominantly performing phacoemulsification (43% vs. 25% performing mostly manual small incision cataract surgery, P < 0.001) and more than 500 cataract surgeries annually (45% vs. 33%, P < 0.001) reported greater use of IC moxifloxacin. Self-reported endophthalmitis rates were statistically significantly greater in those not using IC antibiotics (0.045% vs. 0.036, P = 0.04). Although a majority of respondents believe that IC antibiotics are an important option (54%) and that it is important to have a commercially available solution (68%), many believe that other antibiotic prophylaxis methods are sufficient (31%).Conclusion:IC antibiotic prophylaxis for cataract surgery has sharply increased in India. In contrast to the West, intraocular moxifloxacin, which is commercially available in India, is preferred by the vast majority of users.

The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery: How Good is the Evidence?

“…Surgeons wishing to improve their endophthalmitis rates should carefully assess all aspects of their operating room preparation and sterile technique. The use of povidone-iodine is the only antibiotic/antisepsis practice supported by level I evidence, but despite this, use of povidone-iodine is only 94% in India, and some aspects of preparation may not be fully optimized [ 58 ]. The authors believe that unless endophthalmitis rates within an institution are less than 1/1000 (0.1%), surgeons should critically evaluate their asepsis practices.…”

“…In most countries it must be compounded prior to use. In India, where over one million cataract surgeries are performed each year, moxifloxacin PF hydrochloride (Promox®; Aurolab, Madurai, India) for intracameral use has been manufactured since 2013, and it currently accounts for more than 90% of intracameral antibiotic use in India [ 58 ]. The Aravind Eye Care System, which comprises ten surgical facilities and considers intracameral moxifloxacin to be standard-of-care after routine surgery, demonstrated a fourfold reduction in the rate of endophthalmitis following cataract surgery [ 57 ].…”

Commentary: Role of antibiotics in cataract surgery

“…[ 1 ] As compared to west, rates of manual small incision cataract surgery are more and intracameral moxifloxacin is also available as an alternative to intracameral cefuroxime in India. [ 2 ]…”

Antibiotic prophylaxis in cataract surgery: Understanding the trends of the day

“…Kelkar et al . in their article “Antibiotics prophylaxis practice patterns for cataract surgery in India – Results from an Online Survey”[ 7 ] could elicit responses from a small number of participants – 1228 respondents (8.2%), which may not be truly representative of the prevalent practices among cataract surgeons in India; however, it does provide insights into POE prevention.…”