Patterns of perioperative prophylaxis for cataract surgery in Canada.
BACKGROUND
The objective of this study was to document prophylactic methods used for cataract surgery in Canada.


METHODS
The Web-based link to a password-protected, anonymous, online survey was e-mailed or mailed, between November 2004 and January 2005, to 800 ophthalmologists practicing in Canada.


RESULTS
Of the 239 respondents (30% response rate), 216 performed cataract surgery. Phacoemulsification was preferred by 99%. Topical antibiotics, of which moxifloxacin was the most common (32%), were used preoperatively by 78%. Intraoperatively, 98% used providone-iodine antisepsis of skin, 15% used intracameral antibiotics and 11% subconjunctival antibiotics. Postoperative topical antibiotics, of which moxifloxacin was the most common (30%), were used by 97%, and 1% routinely used postoperative systemic antibiotics. Prophylactic regimen was changed after vitreous loss by 39%, of whom 68% added systemic antibiotics. Reported mean rate of postoperative endophthalmitis occurring within the previous year was 0.088%. Community practicing ophthalmologists were more likely to use preoperative topical antibiotics (p = 0.0016, chi2). As case volume increased, surgeons were more likely to use intracameral antibiotics (p = 0.0185, exact Mantel-Haenszel chi2 test) and postoperative topical antibiotics (p = 0.0044, exact Mantel-Haenszel chi2 test), and less likely to use subconjunctival antibiotics (p = 0.0011, exact Mantel-Haenszel chi2). As time in practice decreased, surgeons were more likely to use postoperative topical antibiotics (p = 0.0319, exact Mantel-Haenszel chi2 test). Provincial region was associated with preoperative topical antibiotic use (p = 0.0076, Fisher's exact test), intracameral antibiotic use (p = 0.0314, Fisher's exact test), and subconjunctival antibiotic use (p = 0.0373, Fisher's exact test). There was no association between reported rate of postoperative endophthalmitis and any form of perioperative antibiotic use.


CONCLUSIONS
Prophylactic methods commonly used for cataract surgery in Canada include providone-iodine antisepsis and perioperative topical antibiotics. Intracameral and subconjunctival antibiotics are currently not common prophylactic methods. Systemic antibiotics are used prophylactically by a subset of ophthalmologists for cases complicated by vitreous loss.
Hammoudi
Dena S
DS
Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada.
Abdolell
Mohamed
M
Wong
David T
DT
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002170:Canada / Q000453:epidemiology; D002387:Cataract Extraction; D034742:Electronic Mail; D009877:Endophthalmitis / Q000453:epidemiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D019990:Perioperative Care / Q000379:methods*; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents