Endophthalmitis remains one of the most serious complications of cataract surgery (see Chapter 11 in this volume). Therefore, a major objective of preoperative preparation and intraoperative management of the patient is to reduce the introduction of pathogenic organisms into the anterior chamber.
Before the day of surgery, the surgeon should identify and reduce infectious risk factors as much as possible through preoperative treatment of coexisting eyelid disorders such as conjunctivitis, blepharitis, hordeolum, and chalazion. Systemic infections should also be identified and treated.
Cataract surgery is not considered to be an invasive procedure that induces transient bacteremia; thus, systemic antibiotic prophylaxis is not required. If questions arise about whether antibiotic prophylaxis is advisable in the perioperative period, the surgeon may wish to consult with the physicians involved in the patient’s systemic care.
Although no studies have convincingly demonstrated the efficacy of topical antibiotics in reducing the risk of endophthalmitis in routine cataract surgery, there is some evidence supporting an association between the use of preoperative topical antibiotics and a reduction in ocular surface bacterial counts, as well as a lower incidence of positive aqueous cultures after surgery. Many cataract surgeons prescribe preoperative topical antibiotics.
For patients with a history of herpetic eye disease, a prescription of prophylactic antiviral medications can be considered. This topic is further discussed in Chapter 12.
Sykakis E, Karim R, Parmar DN. Management of patients with herpes simplex virus eye disease having cataract surgery in the United Kingdom. J Cataract Refract Surg. 2013;39(8): 1254–1259.
Yoshida J, Kim A, Pratzer KA, Stark WJ. Aqueous penetration of moxifloxacin 0.5% ophthalmic solution and besifloxacin 0.6% ophthalmic suspension in cataract surgery patients. J Cataract Refract Surg. 2010;36(9):1499–1502.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.