Not using intracameral antibiotics puts your patients at risk of endophthalmitis

In a letter to the journal Ophthalmology, Deepa Anijeet, MD, makes the case that there is strong evidence that intracameral antibiotic prophylaxis reduces endophthalmitis incidence after cataract surgery. He hypothesizes that the difference in endophthalmitis rates between Hatch et al's Canadian population-based study published in March and Lundstrom et al's previously published Swedish study (1.4 vs. 0.5 per 1000) is due to intracameral antibiotic use. Intracameral cefuroxime was used in 99 percent of surgeries in the Swedish study, whereas their use was unclear in the Canadian study.

Despite this evidence, the letter's author writes, there is reluctance to accept this practice. No studies have reported toxic corneal effects due to their use. However, surveys have found that the lack of a commercially available antibiotic preparation appropriate for intracameral use may be limiting post-cataract surgery intracameral antibiotic use.

The author concludes that due to the clear protective effect of intracameral antibiotics on the prevention of postoperative endophthalmitis, ophthalmologists need to adopt their use. Not giving them after cataract surgery should be considered a risk factor for developing endophthalmitis.