Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery

Abstract

Importance: Although the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics.

Objective: To compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine.

Design, setting, and participant: This was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included.

Exposure: Povidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears.

Main outcome and measure: Postoperative endophthalmitis incidence.

Results: Postoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000).

Conclusions and relevance: No difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.

Figure.. Incidence of Endophthalmitis After Cataract Surgery With and Without Intracameral Antibiotics

Blue indicates with antibiotics; orange, without, as reported in 37 studies, and in the Rotterdam Eye Hospital from 2016 to 2022. Postoperative endophthalmitis incidence in the Rotterdam Eye Hospital without standard prophylactic use of intracameral antibiotics did not differ from the overall mean incidence of 37 studies in which prophylactic intracameral antibiotics were used. In Rathi et al, reported incidence and study period were used to estimate totals of surgical procedures and postoperative endophthalmitis cases for the no antibiotic group assuming that number of surgical procedures per month was constant. For analytical purposes, in Beselga et al, Rush et al, and Ng et al, the incidence of 0 in the antibiotics group was replaced by 0.5.