Increased Uptake of Intracameral Antibiotic Prophylaxis in Europe
To determine the use of intracameral cefuroxime at the end of cataract surgery across Europe since the beneficial results were first reported by the ESCRS Endophthalmitis Study Group in 2007 and examine the reasons for the different practice patterns identified.
The ESCRS conducted a survey of 250 ophthalmic surgeons across Europe regarding their awareness of the ESCRS study and seeking the reasons for their current use or non-use of i/c antibiotics in their cataract surgery. Simultaneously, data on practice patterns for prophylaxis were searched in the main European countries concentrating on the uptake of the i/c route and the reasons for the switch.
In the ESCRS survey, 74% always/usually use i/c antibiotics and 82% of these use cefuroxime. Lack of need, protocol, or concerns re adverse events related to the absence of an approved product, accounted for non-use. Only 8% would not use i/c cefuroxime whether commercially available or not. Germany has the lowest use and the highest cataract volume whilst France has the next highest volume and the most rapid conversion due to Government guidelines introduced in 2011. The approval of a product of i/c cefuroxime for use in cataract surgery by the EMA (European Medicines Agency) in 2012 eliminated the risks of errors of dilution, diluent, contamination or TASS and is largely responsible for the major shift to the i/c route.
The landmark ESCRS Study results of 2007 heralded a worldwide increase in the use of i/c antibiotic for the prevention of postoperative endophthalmitis following cataract surgery. Subsequent studies all over the world have validated these results - where the rate was high it got much lower, where it was low it got even lower with almost no adverse events. We recommend it to our American colleagues.