EyeWorld India March 2015 Issue

March 2015 12 EWAP FEATURE Results of 2014 ASCRS endophthalmitis antibiotic prophylaxis survey by David F. Chang, MD EyeWorld Chief Medical Editor Experienced surgeons discuss the benefits and drawbacks of available choices I n 2007, the ASCRS Cataract Clinical Committee surveyed the membership regarding endophthalmitis antibiotic prophylaxis practice patterns. 1 The prospective, randomized ESCRS endophthalmitis prophylaxis trial first reported in 2006 had shown a 5-fold reduction in endophthalmitis rates with intracameral injection of cefuroxime at the conclusion of cataract surgery (0.07% versus 0.34% without intracameral cefuroxime). 2 The goal of the ASCRS survey was to evaluate the use of both topical and intracameral antibiotic prophylaxis and to assess the impact of the ESCRS study in terms of the use or perceived need for direct intracameral antibiotic injection. A total of 1,312 members responded to the 2007 online survey (an 18% response rate). Of the 30% who were using intracameral antibiotics, there was a 50/50 split between those placing antibiotic in the infusion bottle versus those injecting it directly. Vancomycin was the most popular agent, preferred by 61% of those using an intracameral antibiotic. Finally, 82% indicated that they would use a commercially available antibiotic for direct injection if it were reasonably priced. In the intervening period, numerous large retrospective studies have been published supporting the efficacy of intracameral cefuroxime. Both the 2011 American Academy of Ophthalmology Cataract Preferred Practice Patterns and a 2011 white paper by the ASCRS Cataract Clinical Committee noted that there was stronger evidence supporting direct intracameral injection than for any other method of antibiotic prophylaxis. 3,4 The 6-year incidence of endophthalmitis from the Swedish National Cataract Register (where intracameral cefuroxime is standard) was reported to be 0.029%. 5 Finally, a 2012 retrospective study from Kaiser documented a 22-fold decrease in endophthalmitis rates over a 4-year period when intracameral antibiotic injection was routinely used with cataract surgery. 6 The other significant development has been the approval of Aprokam (cefuroxime, Thea Group, Clermont-Ferrand, France), a commercial preparation of cefuroxime for intracameral injection, in 24 European countries. 7,8 To date, the company AT A GLANCE • In 2007, the Cataract Clinical Committee surveyed the ASCRS membership regarding endophthalmitis antibiotic prophylaxis practice patterns. • The membership was resurveyed in August 2014, and most of the same questions from 2007 were repeated so that differences and trends could be analyzed. • The 2014 survey found there has been a distinct trend toward greater use of intracameral antibiotics by ASCRS members since 2007. Figure 1. Preferred perioperative topical antibiotic Figure 2. Responses of survey participants using intracameral antibiotics Figure 3. The survey asked, “Have you initiated intracameral antibiotic injections during the past 2 years?” 47% already or plan to use intracameral antibiotic injections. Source (all): David F. Chang, MD