13.2 Cataract

ESCRS [viii]

Intracameral cefuroxime decreased risk of endophthalmitis by 5x

Risk higher if male, CCI (c.f. scleral tunnel), & silicone IOL

Use of perioperative levofloxacin drops as prophylaxis was associated with reduction in endophthalmitis, although not statistically significant

Four groups studies – no drops/injection, intracameral, drops/no intracameral, drops and intracameral (lowest rate of endophthalmitis)

EVS [ix]

Endophthalmitis Vitrectomy Study

If VA LP at presentation endophthalmitis, do better with initial vitrectomy rather than intravitreal antibiotics (3x increased chance of achieving 6/12)

IV antibiotics make no difference

Very old study, may not be applicable today, high rate of endophthalmitis in study, multiple problems with protocol)

Povidone [x]

Pre-op povidone-iodine preparation reduces the risk of endophthalmitis. 5% concentration is more efficacious than 1%

Apt, L., Isenberg, S., Yoshimori, R. et al. 1984. Chemical Preparation of the Eye in Ophthalmic Surgery: III. Effect of Povidone-Iodine on the Conjunctiva. Archives of Ophthalmology 102(5) 728-729.

ESCRS PREMED 1 [xi]

Prevention of post-op CMO in non-diabetics

Comparison of topical NSAIDs, topical steroids, or both in prevention of post-op CMO in uncomplicated cataract surgery. Findings – patients receiving combination bromfenac (0.09%) BD for 3/52 combined with dexamethasone 0.1% for 4/52 had lower risk of developing post-op CMO

Wielders, L.H.P., Schouten, J.S.A.G., Winkens, B. et al. 2018. European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1. Journal of Cataract & Refractive Surgery 44(4).

          

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