Topical antibiotics are unnecessary after routine cataract surgery, but intracameral antibiotics must be used to prevent endophthalmitis.
Let us be more specific, topical antibiotics after cataract surgery are not necessary, according to Alexander James Silvester, MBCHB, as long as surgeons tick off all the boxes on the safety check list.
To lessen the postoperative burden on patients who underwent cataract surgery by eliminating the topical antibiotic regimen, Dr. Silvester emphasized that the surgery must be uncomplicated and have no dropped nucleus or posterior capsular rupture.
And, importantly, instillation of intracameral antibiotics is a must. Surgeons in the UK have a licensed intracameral antibiotic to rely on, Aprokam (Cefuroxime), that is used in all cases.
While the endophthalmitis rate in the UK is only 0.03% after cataract surgery, the fear is that superbugs will surge ahead and dramatically increase that incidence rate.
“Overuse or inappropriate use of antibiotics is the largest cause of antibiotic resistance,” said Dr. Silvester, an ophthalmologist and medical director of the SpaMedica group of eye hospitals, Bolton, UK.
Studies over the past eight years; a systematic review (Kessel et al. 2015), a retrospective study of 15,000 eyes (Raen et al. 2013), and review of the Swedish National Cataract Registry (Behndig et al. 2011), supported the notion of eliminating antibiotic drops after cataract surgery.
“All found that topical postoperative antibiotics are not important in preventing endophthalmitis after cataract surgery when the patients have received intracameral antibiotics,” Dr. Silvester said.
Published guidelines from the European Society of Cataract and Refractive Surgeons (ESCRS) in 2018 issued a statement that topical antibiotic drops confer no added benefit over intracameral cefuroxime.