Minimizing the risk of endophthalmitis following cataract surgery: Current antibiotic approaches

Abstract

ABSTRACTIntroduction Cataract surgery is the most commonly performed intraocular surgery all over the world. Endophthalmitis is a sight-threatening complication subsequent to intraocular procedures, open-globe injuries, metastatic systemic infections, and systemic inflammatory diseases. The incidence of post-cataract surgery endophthalmitis is 0.012% to 1.3%.Areas covered Patients’ ocular surface flora, surgical instruments, and surgical complications like posterior capsule rupture with vitreous loss and anterior vitrectomy. The most common bacteria causing post-cataract endophthalmitis in the Western world are gram-positive coagulase-negative Staphylococci, followed by Streptococci and Pseudomonas aeruginosa. Povidone-iodine (PI) is the only topical prophylactic antiseptic known to reduce endophthalmitis perioperatively with a three to five times reduction rate within one minute of irrigation. The European Society of Cataract & Refractive Surgeons (ESCRS) study recommendations are also discussed.Expert opinion There are no randomized controlled trials of PI with endophthalmitis rate as the primary end point. Based on retrospective data, 5% PI applied to conjunctiva prior to surgery reduced endophthalmitis rates four-fold. Intracameral injection of either vancomycin, cefazoline, cefuroxime, or moxifloxacin has a prophylactic effect. We recommend using preoperative 5% povidone-iodine for 30 seconds in the cul-de-sac and intracameral moxifloxacin or cefuroxime as effective prophylaxis against post-operative endophthalmitis.KEYWORDS: Endophthalmitisprophylaxisintracameral antibioticsintracameral moxifloxacinpovidone-iodineDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Table 2 Identified Risk factors and associationDownload CSVDisplay TableAdditional informationFundingThis paper was supported by funds from the Hyderabad Eye Research Foundation.