Eye surgeons should use intracameral antibiotics only in select situations; they should avoid aminoglycosides, and they should not use vancomycin as prophylaxis.
Those are the guidelines Michael Jumper, MD, West Coast Retina, San Francisco, would prefer if he were having eye surgery. Dr. Jumper offered this perspective as part of an overview of antibiotics used in intraocular surgery during the Glaucoma Symposium at the 2017 Glaucoma 360 meeting.
The rate of endophthalmitis is about 1/2,000 in intraocular surgery, Dr. Jumper said. The most common sources of infection are the lids, the adnexa, and the respiratory flora in patients receiving injections in the office. According to one estimate, 6 million intraocular injections were given in U.S. clinics in 2016.
The most common organisms are gram-positive bacteria: coagulase-negative Staphylococci, Staphylococus aureus, and Streptococcus species, he said.
According to one study, Dr. Jumper cited that on endophthalmitis vitrectomy, about 50% of patients ended up with 20/40 or better vision and 75% had 20/100 or better vision, but 5% had no light perception