ESCRS postoperative endophthalmitis study results minimally affect U.S. practice patterns so far

November 12, 2007

According to the results of an online survey conducted by the ASCRS (American Society of Cataract and Refractive Surgery) Cataract Clinical Committee, the results of the ESCRS (European Society of Cataract and Refractive Surgeons) study of endophthalmitis prophylaxis do not appear to have had a significant impact on the practices of U.S. cataract surgeons, said David F. Chang, MD, at Spotlight on Cataracts 2007.

According to the results of an online survey conducted by the ASCRS (American Society of Cataract andRefractive Surgery) Cataract Clinical Committee, the results of the ESCRS (European Society ofCataract and Refractive Surgeons) study of endophthalmitis prophylaxis do not appear to have had asignificant impact on the practices of U.S. cataract surgeons, said David F. Chang, MD, at Spotlighton Cataracts 2007.

Open to ASCRS members, the survey was performed in January 2007 and captured about 1,300 responses.The participants were predominantly U.S. surgeons, but represented a broad distribution of surgicalvolumes.

Of the survey respondents, 16% said they were already using an intracameral antibiotic before theESCRS study, but only 7% had started based on its results, whereas 77% still were not.

For surgeons using an intracameral antibiotic, vancomycin was the most frequent choice (61%). Amongthe non-users, the most common reason cited (89%) was a need for further study. However, 45% wereconcerned about risk and 17% about cost.

When asked whether they would consider an intracameral antibiotic if a product for direct injection wascommercially available, 47% said yes and another 35% said they would depending upon the cost.

"One can only speculate why the ESCRS study has not had more of an impact," Dr. Chang said. "The mostcommon practice for antibiotic prophylaxis among the survey participants involved use of afourth-generation fluoroquinolone started 1 to 3 days preoperatively and continued immediately aftersurgery. In the ESCRS study, levofloxacin was used and not started until the morning aftersurgery.

"Therefore, the ESCRS study did not answer whether intracameral cefuroxime is as good as, better than,or useful added to the most commonly used topical antibiotic protocol in this country," he said. "Thefact that 82% of respondents indicated they would at least consider using intracameral antibiotics ifa product was commercially available is an important message to our partners in industry."