EyeWorld India March 2015 Issue

18 March 2015 EWAP FEATURE Views from Asia-Paci c: Prevention of Endophthalmitis Views from Asia-Paci c: Management & Treatment of Endophthalmitis Aditya KELKAR, MD Consultant eye surgeon National Institute of Ophthalmology 1187/30 Off Ghole Road, Shivaji nagar, Pune 411005 Tel. no. +0091-20-25536369 Fax no. +0091-20-25534572 adityapune4@gmail.com E ndophthalmitis is the most feared complication following cataract surgery. Prevention of endophthalmitis is a painstaking yet rewarding task in comparision to its treatment. We practice thorough patient screening with view of local and systemic infections. Instillation of povidone iodine 5% in the conjunctival sac and painting with 10% iodine solution followed by a strict minimum of 3 minutes of contact time before draping as part of the routine surgical preparation is mandatory in all cases. Optimum use of accessories like powder-free gloves, disposable surgical draping, and steri-strips for care of lashes and eye patch when necessary should be encouraged. Importance of surgical competency and care to minimize the chances of intraoperative complications cannot be overemphasized. Pre-loaded IOLs are recommended along with watertight closure of the incision; suture may be used if required to ensure such wound security. Laminar air ow in theaters, preferably, with strict adherence to cleaning, sterilization, and disinfection protocols is a must. As far as the antibiotic policy of our institute is concerned, a preoperative topical 4th generation uroquinolone every 15 minutes, starting 2 hours prior to surgery and continuing hourly after surgery on the rst day followed by tapering over 2 weeks forms a part of our preferred practice. The use of intracameral antibiotics such as cerfuroxime although highly recommended by the ESCRS study group has had slow acceptance among ophthalmologists in India probably due to lack of availability of an approved product. Editors’ note: Dr. Kelkar has no nancial interests related to his comments. Manish NAGPAL, MD Consultant VR surgeon Retina Foundation Shahibag, Ahmedabad-4, Gujarat, India Tel. no. +91-9824019850 drmanishnagpal@yahoo.com P ostoperative endophthalmitis, though rare, remains one of the most feared complications of cataract surgery. With the advent of new drugs as well as new management strategies the overall outcomes of a patient who has developed endophthalmitis have remarkably improved. However, it is still best prevented. To my mind the two factors which have reduced the incidence were the liberal use of povidone iodine during surgery and the transition from open chamber extracapsular surgery towards closed chamber phacoemulsi cation. The positive anterior chamber pressure throughout the surgery prevents conjunctival ora from migrating inside. Regarding the role of intracameral antibiotics, there is no unanimous approach as it is dif cult to nd a study which could look into such large numbers of cases to justify it with proof of it having actually prevented infection. However, in practice, most surgeons in india do use intracameral antibiotics at the end of surgery and as of now the preferred drug of choice is moxi oxacin. The choice is based on ease of usage directly from the eye drop preparation that is easily available instead of a special preparation which is required with some of the other drugs. Since we don’t have absolutely clearly de ned data on the ef cacy of these injections I think most surgeons would use one or more of the following approaches as prophylaxis: pre- and postoperative topical antibiotics, intracameral antibiotics, and subconjunctival injections, depending on whatever strategy a particular surgeon has been practicing. Editors’ note: Dr. Nagpal has no nancial interests related to his comments.