EyeWorld India March 2015 Issue

March 2015 16 EWAP FEATURE 65% of survey respondents were from the U.S. The survey asked “When do you start preoperative topical antibiotic?” Trends in intracameral antibiotic use by Michelle Dalton EyeWorld contributing writer Differences between U.S. and European surgeons analyzed Y ears after the ESCRS Endophthalmitis Study Group’s study was presented and published, cataract surgeons are still debating the merits of intracameral antibiotic use as a prophylaxis for endophthalmitis—and which agent would be best, when to initiate topical drop use, and how long to use antibiotics postoperatively. The ASCRS Cataract Clinical Committee developed “a brief one-time questionnaire to poll members about their current antibiotic prophylaxis practices.” Here, EyeWorld asked two of the committee members to comment about the trends, the implications for surgeons and patients, and what may happen down the road with endophthalmitis prophylaxis. What struck Rosa Braga- Mele, MD, the most was that some surgeons “don’t use any type of co-antibiotics,” which would be worrisome unless those same surgeons are just using intracameral, she said. Dr. Braga- Mele is professor of ophthalmology, University of Toronto, director of cataract surgery, Kensington Eye Institute, Toronto, and director of professionalism and biomedical ethics, Department of Ophthalmology, University of Toronto. A small number of the respondents were outside the U.S., and drawing any definitive conclusion would be difficult, said Nick Mamalis, MD , professor of ophthalmology, director of the Intermountain Ocular Research Center, and director of ocular pathology, John Moran Eye Center, University of Utah, Salt Lake City. In the ESCRS study, the researchers chose cefuroxime as the intracameral antibiotic of choice; at the time the study was designed, fourth-generation fluoroquinolones were not commercially available. As such, when cefuroxime is discussed during the ASCRS survey, it is likely to be by the Europeans because neither Canada nor the U.S. has a commercially available formulation designed for ocular use. The overall risk of endophthalmitis is rather low—Dr. Mamalis estimates it at about 1:1500—and that may help explain the varied responses, he said. Of the ASCRS respondents who said that they do not inject intracameral antibiotics, almost 50% said they were not convinced of the need. “For me, I don’t have enough evidence that using intracameral antibiotics will make a difference in my patient population,” Dr. Braga-Mele said. Some surgeons will continue to be cautious about introducing another substance into the eye “with the possibility of introducing a different kind of problem such as toxic anterior segment syndrome (TASS) when AT A GLANCE • Intracameral antibiotics are used more outside the U.S. • Studies confirm intracameral antibiotic use reduces the risk of endophthalmitis. • U.S. requirements for safety and efficacy mean it is unlikely intracameral antibiotics will be approved for endophthalmitis prophylaxis. Of the respondents who said they do not inject intracameral antibiotics, almost 50% said they are not convinced of the need. Source: ASCRS