EyeWorld India June 2017 Issue

June 2017 24 EWAP SECONDARY FEATURE An eye with endophthalmitis Source: Andrzej Grzybowski, MD Although evidence of the benefits of intracameral antibiotics continues to mount, some say additional steps are needed before widespread adoption R esearch evidence of the anti-endophthalmitis benefits of intracameral antibiotics continues to accumulate, but questions continue over whether it is clearly time for U.S. cataract surgeons to move to the prophylactic, say observers. “I think it is up to the individual surgeon to make a decision on whether or not they feel it is the time to start incorporating intracameral antibiotics,” said Nick Mamalis, MD , professor of ophthalmology, John Moran Eye Center, University of Utah, Salt Lake City. Dr. Mamalis noted that the incidence of postoperative endophthalmitis in the first world has dropped markedly over the Is it time to move to intracameral antibiotics? by Rich Daly EyeWorld Contributing Writer AT A GLANCE • Individual surgeons are best positioned to decide whether it is time to use intracameral antibiotics. • Rare problems require careful monitoring of the compounding process. • There is no evidence to support the use of topical antibiotics when IC antibiotics are used. • ASCRS is working toward regulatory approval of a pre- mixed, single-use antibiotic for intracameral injection. last 30 years to about one in 1,500 cases—even without intracameral antibiotics—due to the use of preoperative povidone iodine, a fourth-generation fluoroquinolone topically, proper wound construction, and intactness of the lens capsular bag at the completion of cataract surgery. “Endophthalmitis has markedly decreased as our surgeries have gotten better, as our techniques have gotten better, as our sterile techniques have improved, and I do think using careful techniques, preop betadine on the eye, sealing the wound, and then immediate postop topical fourth-generation fluoroquinolones have been very efficacious in preventing endophthalmitis,” Dr. Mamalis said. But in recent years a growing share of ophthalmologists have become convinced of the additional protective benefits of intracameral antibiotics. “Intracameral antibiotics were viewed with skepticism when first introduced,” said Bonnie Henderson, MD , clinical professor of ophthalmology, Tufts University School of Medicine, Boston. “However, the body of evidence that it is effective and safe is so overwhelming that most physicians accept it as a viable method to prevent infection. The biggest obstacle for using intracameral antibiotics in the U.S. is not because of a question of its efficacy but rather the lack of availability of a [U.S. Food and Drug Administration, FDA] approved product.” Widespread European use of a trial-tested formulation of cefuroxime (Aprokam, Thea Pharmaceuticals, Clermont- Ferrand, France)—about 75% of surgeons in ESCRS use intracameral antibiotics—demonstrated the appeal of such a treatment option.¹ Research continues In the 3 years since release of the ASCRS 2014 Intracameral Antibiotic Review and Position Paper 2 , additional U.S. and international studies have been published that demonstrated intracameral antibiotics’ ability to reduce postop endophthalmitis, Dr. Mamalis noted. The largest U.S. study was done by a Kaiser Permanente group using either cefuroxime continued on page 26