In 1991, a study by Speaker et al. demonstrated that microorganisms from the patient’s external tissues were the source of postoperative endophthalmitis, and preoperative preparation of the ocular surface with topical povidone-iodine is considered standard of care for reducing infection risk after surgery. Topical antibiotics pre- and postoperatively have also been used routinely despite absence of prospective studies demonstrating benefit for this approach.
“There are no studies that have shown superiority of topical antibiotic treatment versus povidone-iodine alone, and there is no consensus about what may be the best topical antibiotic for preventing endophthalmitis, although fluoroquinolones are used most often,” said Dr. Henderson.
There is very strong evidence supporting the efficacy of intracameral antibiotics for reducing the risk of postoperative endophthalmitis. Initial results from the landmark ESCRS study of prophylaxis of postoperative endophthalmitis were published in 2006 and showed that intracameral cefuroxime significantly reduced the risk for developing endophthalmitis after cataract surgery. Subsequently, findings of prospective studies conducted in Sweden and Kaiser Permanente in California among others support the use of intracameral antibiotics, Dr. Henderson said.
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.