Perspective on 2013 Cochrane Review of Prophylactic Intracameral Antibiotics in Cataract Surgery

Sunday, April 27, 2014: 4:08 PM
Room 152 (Boston Convention and Exhibition Center)
Steve A. Arshinoff, MD, FRCSC, York Finch Eye Associates, Toronto, Ontario, Canada

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.