VARIED RESULTS

A survey of European cataract surgeons reveals that there is considerable variation in the measures taken to avoid postoperative endophthalmitis, said Uwe Pleyer MD, Eye Clinic of the University Hospital, Charité, Berlin, Germany, at the 18th ESCRS Winter Meeting in Ljubljana.

The participants included 479 cataract surgeons from nine European countries, with between 19 and 100 surgeons per country, one surgeon per clinic. All completed a questionnaire regarding the endophthalmitis prophylaxis measures they took before, during and after cataract surgery.

The survey revealed that there is at present little in the way of an international consensus regarding infection prophylaxis measures taken before the patient arrives in the operating room. For example, in the UK the percentage of surgeons who prescribe preoperative topical antibiotics is very low, 1.3 per cent, while in Italy 80 per cent prescribe them. Overall, 42 per cent of ophthalmologists surveyed prescribed preoperative topical antibiotics

Once the patient is in the surgical theatre, the use of antisepsis is nearly universal with povidone iodine being the most popular agent, followed by chlorhexidine. However, the concentrations used varied considerably, in the case of povidone iodine, from one per cent to 10 per cent. The median time that the iodine was applied before surgery was suboptimal at 120 seconds. Research has shown that most complete antisepsis is achieved with a three-minute application.

Regarding the use of intracameral antibiotics, 66 per cent of respondents said they used them in all of their cataract procedures, 29 per cent said they never used them and the remaining 15 per cent said they only used them in specific cases. Preparation of antibiotics was performed by nurses in 77 per cent of centres, hospital pharmacies in 20 per cent, compounding pharmacies in nine per cent, and by the surgeon in seven per cent of cases.

The use of intracameral antibiotics varied from country to country, from 100 per cent in Sweden and 95 per cent in Spain to 36 per cent in Germany. Cefuroxime was the most widely used. Other agents included vancomycin and moxifloxacin.

Regarding the use of antibiotics after surgery, 47 per cent prescribed topical antibiotics and steroids, 40 per cent prescribed NSAIDs with-or-without antibiotics, 34 per cent prescribed steroids alone, and five per cent prescribed NSAIDs plus antibiotics. Among those prescribing postoperative antibiotics, length of treatment ranged from one week to more than two weeks.

Dr Pleyer noted that the study’s authors include one key opinion leader from each country surveyed, together comprising the ETHICS (European Team for the prophylaxis of infection in Cataract Surgery) board. Their plan is to conduct the survey in addition to other information-gathering approaches annually to obtain the up-to-date on current practice in cataract surgery.

Uwe Pleyer: uwe.pleyer@charite.de