AAO 2026: Are topical antibiotics necessary after intracameral prophylaxis in cataract surgery: is enough enough?

The debate about the need for administration of topical antibiotics following intracameral prophylaxis during cataract surgery has been ongoing. Muhammad Zain Chauhan, MD, MS, addressed the issue of whether topical antibiotics add protection when intracameral prophylaxis was already used at the 2026 annual meeting of the American Academy of Ophthalmology in New Orleans. He is from the Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock.

The question currently remains unanswered, with some evidence suggesting Yes¹ and others suggesting No.² Chauhan and colleagues conducted a study that points to No.

Study design and results

In a retrospective, multicenter cohort study that aimed to resolve this issue, Chauhan and colleagues compared two groups, one of which was treated with only intracameral antibiotics and the other with both intracameral and topical antibiotics after cataract surgery. The investigators hypothesized that adjunctive topical antibiotics would not be associated with a measurable reduction in risk. The primary endpoint was the 120-day coded (H44.0 or H44.1) outcome risk.

The study was comprised of 37,051 patients before matching. After matching, the intracameral and the intracameral plus topical groups included 8,607 patients each; the final sets were 8,563 and 8,559 patients, respectively.

The investigators reported that among the unmatched patients who received only intracameral antibiotics and those who received intracameral plus topical antibiotics, the risk ratio was 1.261 (95% confidence interval [CI], 0.666-2.388) (P = 0.4757; in the matched patients, the risk ratio was 1.000 (95% CI, 0.464-2.155) P = 0.990). in 26 match events, no difference was detected.

In this current study, the investigators reported no detectable adjunctive topical association in a documentation-defined, matched cohort.

Chauhan and colleagues determined that in this multicenter cohort, adjunctive topical antibiotic documentation was not associated with a statistically detectable reduction in 120-day coded endophthalmitis-related events after intracameral prophylaxis.

References
1. European Society of Cataract and Refractive Surgeons. European Study Group. J Cataract Refract Surg. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg.2007;33:978-88.doi: 10.1016/j.jcrs.2007.02.032.
2. Herrinton LJ, Shorstein NH, Paschal JF, et al. Comparative effectiveness of antibiotic prophylaxis in cataract surgery. Ophthalmology. 2016;123:287–94. doi: 10.1016/j.ophtha.2015.08.039.