Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Abstract

Background Endophthalmitis is a severe inflammation of the anterior or posterior (or both) 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. Objectives To evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery compared with no prophylaxis or other form of prophylaxis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to December 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 used no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 6 December 2016. We also searched for additional studies that cited any included trials using the Science Citation Index. Selection criteria We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. We included trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic), or postoperative antibiotic prophylaxis for acute endophthalmitis. We excluded studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine or antibiotics for treating acute endophthalmitis after cataract surgery. Data collection and analysis Two review authors independently reviewed abstracts and full-text articles for eligibility, assessed the risk of bias for each included study, and abstracted data. Main results Five studies met the inclusion criteria for this review, including 101,005 adults and 132 endophthalmitis cases. While the sample size was very large, the heterogeneity of the study designs and modes of antibiotic delivery made it impossible to conduct a formal meta-analysis. Interventions investigated included the utility of adding vancomycin and gentamycin to the irrigating solution compared with standard balanced saline solution irrigation alone, use of intracameral cefuroxime with or without topical levofloxacin perioperatively, periocular penicillin injections and topical chloramphenicol-sulfadimidine drops compared with topical antibiotics alone, and mode of antibiotic delivery (subconjunctival versus retrobulbar injections; fixed versus separate instillation of gatifloxacin and prednisolone). The risk of bias among studies was low to unclear due to information not being reported. We identified one ongoing study. Two...

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

“…While the debate regarding the safety and efficacy of using IC antibiotic prophylaxis continues, a recent Cochrane review[ 56 ] analyzed studies that had been published through December 2016 and concluded that the 2007 ESCRS study demonstrated the efficacy of using IC antibiotics for reducing endophthalmitis. However, the antibiotic of choice may differ based on the clinical setting.…”

Epidemiology and outcomes of Endophthalmitis in chronic dialysis patients: a 13-year experience in a tertiary referral center in Taiwan

“…Male gender and DM have been described as patient-associated pre-operative risk factors for post cataract surgery endophthalmitis [ 11 ]. Based on previous studies and meta-analysis, prophylaxis with intracameral injection of cefuroxime reduce the rate of post cataract surgery endophthalmitis [ 27 – 29 ]. Because our patients underwent cataract surgery in other ophthalmologic clinic, we were not aware of the use of prophylaxis antibiotic during the surgery.…”

Prophylactic intracameral levofloxacin in cataract surgery – an evaluation of safety

“… 1 , 5 Although several studies of intracameral injection have reported reduced rates of endophthalmitis, compared with no antibiotic injection, the choice of antibiotic has varied, including moxifloxacin, vancomycin, and cefuroxime, and the ideal choice of antibiotic agent remains unclear. 4 , 12 Additionally, identified barriers to provider uptake have included a lack of commercially available preparations and concerns regarding dilution errors and risk of contamination when compounding the drugs for required doses. Ophthalmologists in the US have indicated that intracameral antibiotic use would likely increase if a single-dose vial was commercially available.…”

“…Although perioperative intracameral antibiotic administration was controversial in the past, a growing body of evidence has demonstrated a significant reduction in the incidence of endophthalmitis when this technique is used. 2 – 4 In addition, the safety of intracameral injection of antibiotics following cataract surgery has been demonstrated by evaluating parameters, including anterior chamber reaction, corneal thickness, and corneal endothelial density. 5 …”