Perspective on 2013 Cochrane Review of Prophylactic Intracameral Antibiotics in Cataract Surgery
Narrative Responses:
Purpose
To analyze the 2013 Cohrane review of intracameral antibiotic prophylaxis for cataract surgery, and current adoption in different countries.
Methods
The world literature on intracameral prophylaxis and post-cataract surgery endophthalmitis was reviewed, along with the recent 2013 Cochrane review. European and American incidences and prophylaxis data were compared.
Results
30% of ASCRS member respondents routinely use intracameral antibiotic prophylaxis during cataract surgery, whereas 55% of European surgeons do, while some countries (e.g. Sweden) reach 100%. Concern for potential dilution errors and possible ensuing toxicity, particularly for cefuroxime, is a factor. Americans prefer to reserve vancomycin as a drug of last resort. Every study, irrespective of baseline infection rate, demonstrates 80%+ reduction of infection rates using cefuroxime, vancomycin or moxifloxacin, suggesting that intracameral antibiotic prophylaxis may be useful everywhere. The Cochrane review found few randomized controlled trials for study, and recommended a comparative study of intracameral cefuroxime and moxifloxacin.
Conclusion
American cataract surgeons could potentially reduce their already very low post-cataract surgery infection rates by adopting the routine use of intracameral antibiotics.