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

Beselga, Diana; Campos, António; Castro, Miguel Ángel; Fernandes, Cristina; Carvalheira, Fausto; Campos, Sonia Sánchez; Neves, A.; Campos, Joana; Violante, Luís; Sousa, João C.

doi:10.5301/ejo.5000417

Cited by 42 publications

(31 citation statements)

References 29 publications

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“…[4][5][6][7][8][9][10][11][12] Among the more recent studies published in 2013, the 6-year incidence of endophthalmitis from the Swedish National Cataract Register (where intracameral cefuroxime is standard) was reported to be 0.029%. 10 In the U.S., a retrospective study that took place at Kaiser Permanente 9 documented a 22-fold decrease in endophthalmitis rates over a 5-year period when intracameral antibiotic injection was routinely used with cataract surgery.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12] Both the 2011 American Academy of Ophthalmology (AAO) Cataract Preferred Practice Pattern Guidelines and a 2011 ASCRS Cataract Clinical Committee review of endophthalmitis prevention noted that there was stronger evidence supporting direct intracameral injection than for any other method of antibiotic prophylaxis. 13,14 In 2013, 15 the ESCRS published endophthalmitis prophylaxis guidelines that reviewed the evidence supporting the safety and efficacy of direct intracameral injection of cefuroxime.…”

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confidence: 99%

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Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey

Chang¹,

Braga-Mele²,

Henderson³

et al. 2015

Journal of Cataract and Refractive Surgery

148

126

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A 2014 online survey of the American Society of Cataract and Refractive Surgery members indicated increasing use of intracameral antibiotic injection prophylaxis compared with a comparable survey from 2007. Forty-seven percent of respondents already used or planned to adopt this measure. One half of all surgeons not using intracameral prophylaxis expressed concern about the risks of noncommercially prepared antibiotic preparations. Overall, the large majority (75%) said they believe it is important to have a commercially available antibiotic approved for intracameral injection. Assuming reasonable cost, the survey indicates that commercial availability of Aprokam (cefuroxime) would increase the overall percentage of surgeons using intracameral antibiotic injection prophylaxis to nearly 84%. Although the majority used topical perioperative antibiotic prophylaxis, and gatifloxacin and moxifloxacin were still the most popular agents, there was a trend toward declining use of fourth-generation fluoroquinolones (60%, down from 81% in 2007) and greater use of topical ofloxacin and ciprofloxacin (21%, up from 9% in 2007).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey

Chang¹,

Braga-Mele²,

Henderson³

et al. 2015

Journal of Cataract and Refractive Surgery

148

126

View full text Add to dashboard Cite

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“…Worldwide, numerous single-center retrospective analyses have been conducted to examine whether changes in practice patterns resulted in reduced endophthalmitis rates. Several studies have reported reduced rates of endophthalmitis following adoption of intracameral or subconjunctival antibiotics (Beselga 2014; Garat 2009; Garcia-Saenz 2010; Montan 2002; Myneni 2013; Packer 2011; Shorstein 2013). The antibiotic of choice has varied across studies of intracameral injections, with moxifloxacin, vancomycin, and cefuroxime all showing a reduction compared with no antibiotic injection (Packer 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Data from Sweden have shown extremely low rates of postoperative endophthalmitis (0.029%) in the presence of intracameral cefuroxime (Friling 2013). In Portugal, a center found that endophthalmitis decreased from 0.26% to 0.0% after introduction of the ESCRS protocol and use of intracameral cefuroxime (Beselga 2014). Several other studies also have reported declines in endophthalmitis.…”

Section: Discussionmentioning

confidence: 99%

“…A single-use vial of cefuroxime, which requires only reconstitution and not dilution, was approved in Europe in 2012 (Thea Laboratories; Keating 2013). Numerous studies in Europe have reported increases in the use of intracameral antibiotics and corresponding decreases in rates of endophthalmitis following the increased use of cefuroxime (Barreau 2012; Beselga 2014; Daien 2016; Haripriya 2016; Jabbarvand 2016). Surveys should be conducted in one to two years to determine whether increased utilization of intracameral antibiotics leads to increased antibiotic resistance or other ocular complications, or both.…”

Section: Authors’ Conclusionmentioning

confidence: 99%

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Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Gower

Lindsley

Tulenko

et al. 2017

Cochrane Database of Systematic Reviews

103

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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...

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Need for Antibiotic Prophylaxis for Pseudophakic Endophthalmitis—Reply

2015

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

Abstract: 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.

Cited by 42 publications

References 29 publications

Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey

Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Need for Antibiotic Prophylaxis for Pseudophakic Endophthalmitis—Reply

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