Despite some evidence about its efficacy—especially in places where there is a relatively high rate of endophthalmitis— intracameral antibiotic use has not been universally adopted for postcataract surgery endophthalmitis prophylaxis. Moreover, different studies show a trend of decreasing risk of intraocular infections in recent years.
Practice patterns for the use of antibiotics to prevent endophthalmitis after cataract surgery vary around the world. However, the reported rate of postoperative endophthalmitis in different countries is similarly low regardless of the preferred route of administration, said Andrzej Grzybowski, MD, PhD, MBA.
Reviewing practice patterns for preventing endophthalmitis post-cataract surgery, he noted a study conducted by the European Society of Cataract and Refractive Surgeons (ESCRS) remains the only prospective, randomized, controlled trial investigating different approaches.
Its results showed use of intracameral cefuroxime reduced the risk of postoperative endophthalmitis by about five-fold compared with topical treatment and that there was no effect of preoperative topical antibiotic treatment with levofloxacin, said Dr. Grzybowski, professor and chairman, Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.
“Adoption of intracameral antibiotics increased in some countries in Europe following publication of the ESCRS study results in 2007 and then after cefuroxime (Aprokam, Thea Pharmaceuticals) for intracameral use became commercially available in 2012,” he said.
“Corresponding with this shift, there was a decline in preoperative use of topical antibiotics.
Topical antibiotics are still being widely used postoperatively for 5 to 7 days, but practice patterns in different European countries still vary, and overuse and misuse of antibiotics remains a problem in different parts of the world,” Dr. Grzybowski said.
Andrzej Grzybowski, MD, PhD, MBA
E: [email protected]
This article was adapted from Dr. Grzybowski’s presentation at the 2017 meeting of the American Academy of Ophthalmology. Dr. Grzybowski is a speaker, consultant, and/ or lecturer for companies that market antibiotics used for cataract surgery endophthalmitis prophylaxis.