Endophthalmitis is a severe inflammation of the eye (anterior chamber, posterior chamber or both) which may or may not be associated with infection. Post-operative exogenous endophthalmitiscaused by direct infection of the eye by micro-organisms that enter the intraocular cavity during or in the days following surgery is a rare but potentially very serious complication.
At the beginning of the 20th century, the incidence of endophthalmitis after cataract surgery was quite high, about 10%. In the 1980s and 1990s, the advent of extracapsular cataract extraction with a scleral/limbal incision, together with the implementation of better hygiene strategies, reduced this rate to about 0.12% in Europe and 0.072% in the United States. The incidence of endophthalmitis increased, however, after the introduction of the phacoemulsification technique and clear corneal incisions; some retrospective studies reported rates between 0.08% and 0.7%, today the incidence is about 0.1%.
Representing a potentially sight-threatening complication, prophylactic measures for endophthalmitis mainly involve the use of targeted antibiotics against various sources of infection. There are several classes of antibiotics that can be used in different ways (injection into the eye, infusion into the blood or eye drops) and in different moments (before, during or after surgery).
A recent and important review, published in The Cochrane database of systematic reviews, in order to establish whether the use of antibiotics at the time of cataract surgery can prevent post-cataract surgery endophthalmitis, analysed all existing studies on this topic to date.
The main results reported are:
–gantibiotics injected into the eye during surgery reduce the possibility of infection;
-the use of antibiotic eye drops in addition to antibiotic injection further reduces the possibility of endophthalmitis compared to the single use of injections or eye drops;
-Injection of antibiotics into the eye at the end of surgery reduces the possibility of post-operative endophthalmitis;
-is very uncertain whether the addition of antibiotic to sterile irrigation fluid, used during cataract surgery, reduces the possibility of endophthalmitis;
-is very uncertain whether the use of antibiotics and steroidsindividually or in combination, make a difference in the possibility of developing endophthalmitis.
Source
Antibiotics at the time of cataract surgery to prevent bacterial infection of the eye. Gower EW et al. The Cochrane database of systematic reviews. 2017;2:CD006364.
Dr. Carmelo Chines
Direttore responsabile
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