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.
A study published in 2013 examining endophthalmitis prophylaxis practices among European cataract surgeons found information on intracameral cefuroxime usage was lacking in some countries and varied significantly.
In Sweden—where the idea of intracameral administration originated—about 90% of surgeons were using intracameral cefuroxime, but the rate was estimated to be ≤20% in Germany and Belgium. A survey of ESCRS members conducted in 2012 found that 74% were using intracameral antibiotics routinely or usually. Similarly, a survey involving 33 centers in Poland found that in 2013-2014, about 70% of cataract surgeons were using intracameral antibiotics.
“In Sweden, Denmark, and France, current guidelines for cataract surgery endophthalmitis prophylaxis recommend intracameral antibiotics without use of preoperative topical antibiotics,” Dr. Grzybowski said. Data from surveys conducted by the American Society of Cataract and Refractive Surgery show increasing use of intracameral antibiotic prophylaxis over time among surgeons in the United States, from 30% in 2007 to 50% in 2014.
Over the same period, there was no change in preoperative or postoperative use of topical antibiotics. Data on practice patterns in the United States were also included in a 2017 paper in which Dr. Grzybowski and colleagues examined practice patterns for endophthalmitis prophylaxis in cataract surgery among surgeons in a number of countries across different continents.
It found that intracameral antibiotic usage was highest in Australia/New Zealand (78%) and the United States (50%), but it was adopted by only about 25% to 30% of surgeons in Canada, Argentina, and Russia and was being used even less frequently in Japan, China, India, and Mexico.
“Despite the wide variation in intracameral antibiotic use across these different countries, the rate of postoperative endophthalmitis was similar to that reported in European countries where intracameral antibiotics is standard practice,” he said.
“A recent study from Japan, where intracameral antibiotics rare rarely used, reported an endophthalmitis rate of about 0.02%, which is much lower than that reported by any studies of intracameral antibiotic use.”
Dr. Grzybowski noted the results from the ESCRS prospective randomized study are often incorrectly generalized, but it is important to keep in mind that every antibiotic is different.
“The ESCRS study only supports use of intracameral cefuroxime. It does not support the effectiveness of intracameral gentamicin, tobramycin, moxifloxacin, and vancomycin,” he said. “Thus, as long as we do not have any other randomized controlled studies of endophthalmitis prophylaxis, we have good scientific evidence for the intracameral use of only cefuroxime.”
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.