Cataract surgery is a safe and effective procedure that can restore vision and improve quality of life. However, one of the most dreaded complications after cataract surgery is the increased vulnerability to postoperative endophthalmitis. Endophthalmitis is an infection of the eye that can cause severe vision loss if not treated promptly. Fortunately, there are steps that can be taken to reduce the risk of endophthalmitis after cataract surgery. The authors searched the literature for randomized controlled trials of cataract surgery evaluating the administration of antibiotics shortly before, during or immediately after surgery to prevent acute endophthalmitis.
Of these four trials, two reported reduced rates of endophthalmitis when comparing antibiotics injected into the eye with antibiotics given in the form of eye drops. In one study, penicillin injected into the eye resulted in a 67 percent reduction in endophthalmitis after surgery. In the most recent ESCRS study, cefuroxime injected into the eye reduced the risk of endophthalmitis by 80 to 90%, depending on whether antibiotic drops were also used. Cefuroxime is widely used in Europe, but to a limited extent in the United States, where some doctors have expressed concern about the risk of contamination or dilution errors during the composition process (preparation of medications for eye use) that could cause eye toxicity (damage). Because clinical trials with rare results require the participation of a large number of participants and are costly to conduct, additional clinical trials are unlikely to assess how well perioperative antibiotic prophylaxis works to prevent acute endophthalmitis after cataract surgery. To reduce the risk of postoperative endophthalmitis, all patients undergoing cataract surgery should be evaluated for any possible risk factors.
Professionals should consider the evidence shown by the ESCRS study, according to which antibiotics injected into the eye are likely to reduce the risk of endophthalmitis after cataract surgery, when they can be obtained and administered in a sterile manner. Early monitoring after cataract surgery is also strongly recommended to detect any signs of endophthalmitis and treat it immediately. In addition, patients should take necessary medication and precautions after surgery to reduce serious complications caused by late diagnosis and treatment of postoperative endophthalmitis. Several factors are thought to contribute to the incidence of endophthalmitis after cataract surgery, including intraoperative risk management and prophylaxis protocols. Prophylactic injections of subconjunctival antibiotics at the
end of cataract surgerydecrease the incidence of postoperative endophthalmitis. The two studies that showed statistically significant differences between treatment groups (Christy 1979; ESCRS 200) included the injection of antibiotics during surgery (one intraocular and one periocular), and treatment groups that included eye injection had the lowest rates of endophthalmitis, ranging from 0.14 to 1.5 cases of endophthalmitis per thousand surgeries. The main outcome of all four studies was postoperative endophthalmitis after cataract surgery.
The endophthalmitis rates (1.0 to 1.1 per thousand surgeries) in that study were comparable to the endophthalmitis rates recorded in the 21st century, despite the fact that the surgery was performed in surgical camps in a developing country and that intracapsular surgery was performed. To summarize, cataract surgery is a safe and effective procedure that can restore vision and improve quality of life. However, post-surgical complications arise even with the best hand. To reduce the risk of postoperative endophthalmitis, all patients undergoing cataract surgery should be evaluated for any possible risk factors that could potentiate its development. Professionals should consider evidence showing that antibiotics injected into the eye are likely to reduce its risk when they can be obtained and administered in a sterile manner.
Early monitoring after cataract surgery is also strongly recommended to detect any signs of endophthalmitis and treat it immediately.