Commentary: Intracameral antibiotic reduces the risk of post-cataract surgery endophthalmitis but does not eliminate it

摘要

Theroutine use ofintracameralantibiotics in cataractsurgery has increased after intracameralcefuroxime was first recommended by the 2007ESCRS Study. Haripriyaetal. hasalso shown that routineintracameralmoxifloxacin prophylaxis iseffectivein causing a 3.5-fold reduction inoverallrates ofendophthalmitis following cataractsurgery (3-fold for manualSICS and nearly 6-fold for phacoemulsification).[1] Sharmaetal. hasrecommended the use of prophylacticintracameralcefuroxime only in high-risk cataractsurgeries in situ ations like posteriorcapsulerupture,vitreous loss, prolonged surgery,etc.[2] Therecent AIOS survey in 2017 showed that only less than 40%respondents used intracameralantibiotics, out ofwhich 36.6%used in allcasesand 46.2%used in high-risk cases only.[3] Moxifloxacinwas the most preferred intracameralantibiotic(preferred by 78%surgeons) followed by gatifloxacin.[3] Thereis no randomized controltrialwhich can suggestan optimalintracameralantibiotic ofchoice,comparing allthealternatives likecefuroxime, vancomycin,and moxifloxacin. Therearealso variousconcerns regarding theroutine use ofintracameralantibiotics likecommercialavailability offormulations, dilution errors,emergence of drug resistance, safety (likehemorrhagic occlusiveretinal vasculitis with vancomycin, macularedema,and retinalinfarction dueto cefuroxime), risk ofanaphylaxis, toxicanterior segmentsyndromeand cost.