Intracameral antibiotics during cataract surgery: efficacy, ... : Current Opinion in Ophthalmology (original) (raw)

CATARACT SURGERY AND LENS IMPLANTATION: Edited by Natalie Afshari

Intracameral antibiotics during cataract surgery: efficacy, safety, and cost–benefit considerations

aShiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA

bDepartment of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea

Correspondence to Natalie A. Afshari, MD, FACS, 9415 Campus Point Dr, La Jolla, CA 92093, USA. Tel: +1 858 534 6290; e-mail: [email protected]

Abstract

Purpose of review

We summarize evidence-based considerations regarding the use of intracameral antibiotics during cataract surgery.

Recent findings

The use of intraoperative intracameral antibiotics reduced the incidence of postcataract surgery endophthalmitis 3.5-fold, with an odds ratio ranging from 0.14 to 0.19. A survey of the American Society of Cataract and Refractive Surgery showed usage of intracameral injections of antibiotics increased by 16% in the United States between 2014 and 2021. The frequency of vancomycin usage has sharply dropped to 6%, while moxifloxacin is now the dominant choice at 83% among respondents. One analysis showed that 2500 patients need to be treated with intracameral antibiotics to prevent one case of endophthalmitis. A 500 μg intracameral moxifloxacin at $22 dollars per dose is cost-effective, including for patients with posterior capsular rupture (PCR).

Summary

Studies substantiate the safety and efficacy of intracameral antibiotics for endophthalmitis prophylaxis. Intracameral moxifloxacin and cefuroxime are the most common choices. While vancomycin shows potential for efficacy, further studies evaluating clinical outcomes are needed. Adverse events are rare and commonly due to errors in preparation. Topical antibiotics do not provide additional prophylactic benefits to intracameral regimens. Intracameral antibiotics given alone are cost-effective.