In addition, a recent meta-analysis by Bowen et al. found that both intracameral cefuroxime and intracameral moxifloxacin reduced the rates of endophthalmitis with minimal or no toxicity. The authors also concluded that intracameral antibiotic administration may be as effective used alone as when combined with a topical antibiotic. Authors of a Cochrane Database Systematic review concluded there is high-certainty evidence that intracameral cefuroxime with or without topical levofloxacin lowers the risk of endophthalmitis after surgery.
Dr. Henderson noted that antibiotics for endophthalmitis prophylaxis have also been given as a subconjunctival injection, but there is no evidence to show this method is superior to other techniques for antibiotic prophylaxis.
Studies have generated conflicting information on whether the risk of endophthalmitis after lens-based surgery is increased when the procedure is performed through a clear corneal incision versus a scleral tunnel incision. Careful construction of the incision, however, is important so that it remains watertight postoperatively and thereby prevents intraocular ingress of bacteria from the ocular surface.
Attention to intraoperative technique is also important for preventing endophthalmitis because prolonged surgery and certain intraoperative complications, including posterior capsule rupture and vitreous loss, are associated with an increased risk of postoperative infection.
Bonnie An Henderson, MD
E: [email protected]
This article was adapted from Dr. Henderson's presentation during Refractive Surgery Subspecialty Day at the 2018 meeting of the American Academy of Ophthalmology. Dr. Henderson is a consultant to Alcon Laboratories, Allergan, Sun Pharmaceuticals, and Kala Pharmaceuticals and receives lecture fees from Alcon.