Prospective randomized controlled trial of the effect of intracameral vancomycin and gentamicin on macular retinal thickness and visual function following cataract surgery.
OBJECTIVE
To investigate whether the use of vancomycin (20 microg/mL) and gentamicin (8 microg/mL) in the infusion fluid at the time of cataract surgery increases the incidence of macular thickening as measured with optical coherence tomography (OCT) following phacoemulsification.


METHODS
A public teaching hospital in Western Australia.


METHODS
Fourty-one patients (50 eyes) with cataracts between 50 and 85 years of age were randomized to receive no antibiotics in the infusion fluid at the time of cataract surgery (control group) or vancomycin (20 microg/mL) and gentamicin (8 microg/mL) in the infusion fluid (antibiotic group). Optical coherence tomography measurements were performed preoperatively and 1 day and 1 and 5 weeks postoperatively. A significant increase in macular thickness (mean of the central 1.0 mm diameter) on OCT was defined as 15 microm or greater. Five weeks postoperatively, the best corrected Snellen acuity and Pelli-Robson contrast sensitivity were measured.


RESULTS
Twenty-five percent in the control group and 38% in the antibiotic group had a significant increase in macular thickness measured on OCT 5 weeks postoperatively (P = .34). The mean contrast sensitivity of patients with increased macular thickness on OCT was 1.26, and in those with no change it was 1.43 (P = .001).


CONCLUSIONS
The use of intracameral vancomycin (20 microg/mL) and gentamicin (8 microg/mL) at the time of cataract surgery had no significant effect on macular thickness or visual function postoperatively. Overall, 31% of eyes showed an increase of 15 microm or greater in central retinal thickness. These patients had significantly reduced contrast sensitivity.
Ball
James L
JL
Sir Charles Gairdner Hospital, Perth, Western Australia. jamesball@doctors.org.uk
Barrett
Graham D
GD
D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015350:Contrast Sensitivity / Q000187:drug effects* / Q000502:physiology; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control; D015817:Eye Infections / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007260:Infusion Pumps; D019654:Lens Implantation, Intraocular; D008266:Macula Lutea / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects; D014792:Visual Acuity / Q000187:drug effects* / Q000502:physiology
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin