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European observatory of cataract practice: infectious post-operative Endophthalmitis Prophylaxis in 2014

Poster Details

First Author: A.Behndig SWEDEN

Co Author(s):                  

Abstract Details

Purpose:

Infectious post-operative endophthalmitis (IPOE) is the most feared adverse event of cataract surgery. Although rare, an increase in the number of cataract operations engendered by demographic changes will, without other intervention, result in an increase in the absolute incidence of IPOE. The objective of the current survey is to assess changes in cataract surgery practice and more specifically in IPOE prophylaxis following the introduction of ophthalmic formulations of cefuroxime for this indication. The baseline survey was completed in 2013.

Setting:

The survey was conducted among practicing cataract surgeons in Belgium, France, Germany, Italy, the Netherlands, Poland, Spain, Sweden and the UK between 19/05/2014 and 4/07/2014. Half of the 490 surgeons also completed the 2013 survey and half were recruited anew for 2014.

Methods:

To be eligible for inclusion, cataract surgeons were required to have at least 5 years of practice and to undertake at least 150 cataract operations annually. Surgeons were included pro-rata depending on the number of cataract surgeons in each country. A total of 254 960 operations were performed annually by the respondents. Surgeons completed a 37 item questionnaire divided into eight categories; screening, surgeon profile, surgical procedure, therapeutic strategies, product use before arrival at the operating room (OR), techniques for mydriasis and anesthesia, product use at the OR, product use after the patient leaves the OR; surgeons’ attitude to guidelines.

Results:

Many parameters were consistent between the surveys. Anti-inflammatory usage remained stable, steroid+antibiotic usage after cataract surgery increased (frequently for more than two weeks using tapering regimens that favour bacterial resistance). The proportion of antibiotic use before and after surgery declined, perhaps associated with a corresponding increase in intracameral cefuroxime use, particularly of the licensed product Aprokam® (Laboratoires Théa). Medico-legal aspects became prominent in encouraging use of intracameral approved cefuroxime. ESCRS guidelines were followed by more surgeons, although national/local guidelines remained preeminent. Half of all surgeons declared experience of at least one case of endophthalmitis in the past 5 years.

Conclusions:

The second year results from the European Observatory in Cataract Surgery highlighted positive changes concerning IPOE prophylaxis such as an increased use of intracameral cefuroxime and reduction in the use of antibiotics prior to and after surgery. Such changes appear to be associated with a greater awareness of ESCRS guidelines and of possible medico-legal aspects. Other changes were less positive including an increased use of post-surgical tapered antibiotic use that may favor resistance.

Financial Disclosure:

One or more of the authors research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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