Review validates intracameral antibiotics in cataract surgery

I'm proud to be a contributor to this review, which makes clear the advantages of intracameral antibiotics for endophthalmitis prophylaxis. It is essentially a plea to industry and the U.S. FDA to make a commercial preparation available in the United States, where it is considered off-label.

Additionally, the article provides a great comparison of the benefits and risks of the top three antibiotic choices, vancomycin, moxifloxacin and several cphalosporins. However the authors write that there is no strong evidence or consensus as to which medication is superior.

Whether to use topical antibiotics in lieu of or in addition to intracameral antibiotic prophylaxis is a controversial topic and one not included in this review. The authors say the advantages of intracameral antibiotics include:

• Ease of delivery
• Reduction in or elimination of the use of topical eyedrops
• Elimination of patient compliance problems with postop use and timing of eyedrops
• Provision of a higher drug concentration at the target site
• Reduced costs

In countries without access to commercially approved preparations, there are potential risks for incorrect dosing, formulation, and preparation. In a 2008 survey of ASCRS members in the U.S., 77% of respondents were not using intracameral antibiotics postoperatively at that time. However, 82% responded that they would likely use it were a reasonably priced commercial preparation available.

As a result, the authors call on the FDA to make development and approval of commercial antibiotic preparations a high priority. It would improve the safety of cataract surgery by providing better endophthalmitis protection and by reducing toxicity risk.