Optimal antibiotic use in cataract surgery

Per Montan MD Per Montan, St Erik Hospital, Stockholm, Sweden, revisited the topic of perioperative antibiotic use in the context of cataract surgery during the Main Symposium on pharmaceutical treatment at the XXXV ESCRS Congress in Lisbon. After thanking the late Peter Barry for his important work on endophthalmitis prophylaxis, Dr Montan stated: “The good news is that endophthalmitis can be prevented.” The three components, besides aseptic technique, are preoperative disinfectants, intracameral antibiotics and possibly added topical antibiotics. But there are still some questions that need to be answered. “For example, what is the ideal time between povidone iodine and surgery?” he asked. “And which intracameral antibiotic is the best choice?” “Cefuroxime is excellent against gram-positive strains, but does not cover enterococci, while moxifloxacin, which is licensed in India but not yet in the EU, is suffering increased resistance among staphylococci and streptococci,” said Dr Montan. There are also potential safety issues with intracameral cefuroxime, primarily if the dosage is accidentally increased. Nevertheless, a clear pattern has emerged regarding intracameral antibiotic prophylaxis. “Whatever the local ‘background rate’ of endophthalmitis prior to widespread use of prophylaxis, the rates of infection are significantly reduced upon adoption,” he said. This is despite the decreased use of topical antibiotics, which he said have widely been abandoned in his native Sweden. “With the gold standard of preoperative disinfectants and intracameral antibiotics, it appears that a rate of one case per 5,000 surgeries might be the new benchmark for postoperative endophthalmitis,” he concluded.