Role of topical, subconjunctival, intracameral, and irrigative antibiotics in cataract surgery.
OBJECTIVE
To summarize current understanding of antibiotic prophylaxis in cataract surgery, with particular emphasis on available evidence and change in practice patterns over the past decade.


RESULTS
Povidone-iodine application prior to cataract surgery remains a universal practice, and is backed by good quality evidence. Subsequent to the results of the European multicenter trial documenting decreased risk of endophthalmitis with intracameral cefuroxime injection at the end of surgery, similar benefit with intracameral antibiotic use has been reported in studies with large sample sizes from multiple centers around the world. There has been a distinct change in practice patterns in many countries, with intracameral antibiotic use becoming part of routine protocol. In the USA, topical fluoroquinolone application remains the most popular mode of antibiotic prophylaxis. A promising approach is the development of novel drug delivery methods like polymeric devices designed for sustained antibiotic release.


CONCLUSIONS
Based on current evidence, the recommended measures for endophthalmitis prophylaxis are preoperative topical instillation of povidone-iodine and intracameral antibiotic injection at the end of cataract surgery.
Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India.
Jayesh
J
Vazirani
Sayan
S
Basu
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002387:Cataract Extraction; D002444:Cefuroxime / Q000627:therapeutic use; D009877:Endophthalmitis / Q000517:prevention & control; D015817:Eye Infections / Q000517:prevention & control; D006801:Humans; D056965:Injections, Intraocular; D011183:Postoperative Complications / Q000517:prevention & control; D011206:Povidone-Iodine / Q000627:therapeutic use; D007507:Therapeutic Irrigation
D000900:Anti-Bacterial Agents; D011206:Povidone-Iodine; D002444:Cefuroxime