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    Cataract surgery: Perioperative intracameral antibiotics should be standard practice

    Results of perioperative antibiotic prophylaxis for cataract surgery 2013 Cochrane review

    Take-home: Perioperative intracameral antibiotics should be standard practice during cataract surgery to prevent postoperative endophthalmitis.

    Toronto—Perioperative antibiotics, whether topical, subconjunctival, or intracameral, are used almost everywhere to prevent acute endophthalmitis, with varying protocols and evidence for efficacy. Intracameral antibiotics should be standard practice during cataract surgery to prevent postoperative endophthalmitis, as all studies of these drugs reported 80% to more than 90% reductions in endophthalmitis, according to Steve Arshinoff, MD, FRCSC, who is committed to use of the drugs.

    A recent meta-analysis published by The Cochrane Collaboration (Gower et al. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery, Cochrane Library 2013, Issue 7, July 2013) pointed to the effectiveness of intracameral antibiotics, but cautioned about the scarcity of published randomized controlled trials and the lack of availability of single-use intracameral antibiotic preparations.

    The meta-analysis reviewed 4 Cochrane criteria qualifying randomized controlled trials that included 100,876 patients, studied 492 postoperative endophthalmitis papers, and evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival, or systemic), or postoperative antibiotic prophylaxis for acute endophthalmitis.

    The conclusion of the meta-analysis, Dr. Arshinoff noted, was based primarily on the European Society of Cataract and Refractive Surgeons (ESCRS) study results because of inapplicability of the other studies to modern phacoemulsification surgery techniques. Also, according to Dr. Arshinoff, because it was generally in favor of the use of intracameral antibiotics, underscored the need for a single-use commercial preparation for intracameral injection, and suggested a study comparing moxifloxacin and intracameral cefuroxime.

    Dr. Arshinoff is an instructor, Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto.

    The authors concluded that “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.”

    The Cochrane Review underscored the importance of decreasing the endophthalmitis incidence and commented that with about 30 million cataract surgeries performed annually, “the best estimate of the infection rate without intracameral antibiotics is 1:1,000 cases, that is, 30,000 cases per year, of which 10,000 cases become blind per year. Therefore, prevention of postoperative endophthalmitis is an important public health goal.”

    Beyond the meta-analysis

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