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A survey of the use of antibiotics in cataract surgery in the United Kingdom

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Session Details

Session Title: Presented Poster Session: FLACS & Others

Venue: Poster Village: Pod 1

First Author: : E.Samia-Aly UK

Co Author(s): :    I. Yip   A. Raj           

Abstract Details

Purpose:

In 2013, the European Surgeons of Cataract and Refractive Surgery (ESCRS) issued guidelines for prevention and treatment of endophthalmitis following cataract surgery, which included a recommendation to use intracameral cefuroxime in penicillin allergic patients and to use intracameral moxifloxacin or vancomycin in cephalosporin allergic patients. Currently in the United Kingdom (UK) the Royal College Of Ophthalmologists’ (RCOphth) cataract guideline precede these guidelines. The purpose of this survey was to determine what is being currently practised in hospitals around the UK, to determine whether there has been a shift in practice.

Setting:

Ophthalmology consultants based in the United Kingdom were asked to fill in a survey, asking questions regarding their use of antibiotics during cataract surgery.

Methods:

A list of consultants and their emails were collated through the Royal College of Ophthalmology Directory, and their departmental websites. These consultants were sent a survey, devised through the website “survey monkey” asking them a series of questions. These questions assessed which antibiotics were being used during cataract surgery, including alternatives if patients were allergic to cefuroxime and penicillin, as well as their observed experience of any antibiotic reactions.

Results:

296 consultants responded to the survey, of which 84% reported to using intracameral cefuroxime during cataract surgery, with the next most common being subconjunctival cefuroxime at 11%. If the patient was allergic to cefuroxime, 61% would use subconjunctival gentamicin, whilst 10% would use intracameral vancomycin. With patients allergic to penicillin, 57% would still use intracameral cefuroxime, compared to 21% using subconjunctival gentamycin. 5 of the consultants reported toxic anterior segment syndrome with cefuroxime and 10 with subconjunctival gentamicin.

Conclusions:

It is clear that a large number of consultants use intracameral cefuroxime as a standard prophylactic antibiotic in patients undergoing cataract surgery. The use of intracameral cefuroxime is reduced when the patient is penicillin allergic despite guidance from the ESCRS study. The survey also provides an update on the prevalence of toxic anterior segment syndrome as a complication of antibiotic use, with a predilection towards subconjunctival gentamicin compared to cefuroxime. This study has highlighted a shift in practice since the ESCRS recommendations, with more Ophthalmologists in the UK using intracameral cefuroxime.

Financial Disclosure:

NONE

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