ENDOPHTHALMITIS PROPHYLAXIS FOR CATARACT SURGERY IS A HOT TOPIC

Endophthalmitis prophylaxis for cataract surgery has become a hot topic again. in the January edition of JCRS the latest figures from the swedish cataract registry show an incidence down to 0.029 per cent in the period 2005- 2010.1 The non-use of intracameral cefuroxime was the greatest single risk factor. Add-on pre-, per- or postoperative antibiotic drops conferred little, if any, extra benefit. in this same issue of JCRS is the first systematic assessment of intracameral cefuroxime in the Us.2 The results of this study coincide remarkably with the results of the ESCRS Endophthalmitis study (16,000 patients in each) in terms of background rate, (0.3 per cent) benefit of intracameral cefuroxime, numbers of streptococcal and staphylococcal infections and visual outcome from these main organisms.

Subsequent to publishing the results of the ESCRS study, others have confirmed the benefits of switching to the intracameral route of administration. The spanish study of 13,652 patients between 1999- 2008 showed a ten-fold reduction.3 A French study of 5,115 patients4 all with uncomplicated surgery showed an even greater reduction as did an Asian study5 of 50,000 patients including both phaco and ECCE and using intracameral cefazolin. in a more recent report from south Africa6 8,190 patients showed a reduction by a factor of seven.

Nonetheless, the lack hitherto of an approved product has resulted in catastrophic errors in dilution7 and contamination.8 This lack is perhaps the major cause of surgeons’ reluctance to convert to the intracameral route. This may now change with the European Medicines Agency (EMA) approval of Aprokam from Thea Laboratories (France).

Given recent disasters from compounding pharmacies in the Us, it is to be hoped the demonstrated benefits of the intracameral approach worldwide and now in the Us will encourage the FDA to approve a product in the Us. As the number of endophthalmitis cases in Europe is now very small, the ESCRS is planning a European Registry of endophthalmitis following cataract surgery. This will serve to track breakthrough organisms and changes in bacterial resistance and antibiotic susceptibilities. i consider every surgeon has a responsibility to submit their endophthalmitis cases to this registry: www.escrs.org.