More evidence supporting intracameral approach to antibiotics

Using a national insurance database based on cataract surgery outcomes, investigators have found that intracameral antibiotics are more effective than a topical agent alone in preventing endophthalmitis, reducing odds by 42%.

Study design

Investigators analyzed 315,246 cataract procedures among 204,515 patients who underwent clear cornea phacoemulsification at 38 surgical centers across California. Surgeons freely choose their prophylactic route and agent, but a uniform practice included the topical application of povidone-iodine before surgery.

Outcomes

The overall rate of endophthalmitis was 0.07% (215 cases). Over the 8-year study period, odds of endophthalmitis dropped by 42% with the use of intracameral antibiotics cefuroxime or moxifloxacin. The study did not find convincing evidence for a difference in effectiveness between those 2 agents.

Combining topical gatifloxacin or ofloxacin with an intracameral agent was not more effective than using an intracameral agent alone (OR 1.63). Additionally, compared with topical gatifloxacin, prophylaxis with topical aminoglycoside was ineffective (OR 1.97).

Consistent with previous studies, posterior capsular rupture was identified as the most significant risk factor, associated with a 3.68-fold increased risk of endophthalmitis. Other risk factors included age greater than 80 years old (OR 1.46) and diabetic retinopathy (OR 1.31). 

Limitations

The study was unable to account for patient nonadherence to orders for topical prophylaxis, which could be significant as studies have shown a wide variability in tear film and anterior chamber antibiotic concentrations due to anatomic and instillation differences.