A new meta-analysis showed that Using intracameral antibiotics after cataract surgery is associated with lower endophthalmitis rates. The study findings were published in the British Journal of Ophthalmology
Dr. Randy C. Bowen of the University of Wisconsin, Madison, said, "The studies in this systematic review made it clear that intracameral cefuroxime and moxifloxacin had minimal or no toxicity events at standard doses."
"This study outlines the significant reduction in postoperative endophthalmitis incidence for patients who received intracameral antibiotics, and it provides a careful analysis of how these antibiotics affect ocular structures," he said.
Dr. Bowen and colleagues compared the efficacy of intracameral cefuroxime, moxifloxacin and vancomycin in preventing endophthalmitis after cataract surgery – and carried out a safety analysis.
Their analysis, including one randomized controlled trial and 16 observational studies comprising over 900,000 eyes, favored the use of intracameral antibiotics over control treatments for lowering endophthalmitis (odds ratio, 0.20; P<0.00001).
On average, weighted postoperative endophthalmitis incidence rates with cefuroxime, moxifloxacin and vancomycin were 0.0332%, 0.0153% and 0.0106%, respectively.
In secondary analyses, no significant difference was found in efficacy of intracameral plus topical antibiotics versus intracameral antibiotics alone. Most studies had low to moderate risks of bias.
Safety analysis showed minimal toxicity for moxifloxacin. Most cefuroxime toxicities were due to dosing errors. Vancomycin was associated with rare toxic retinal events.
Considering possible areas for further research, Dr. Bowen noted, This study targeted intracameral antibiotics. The question remains as to whether intracameral antibiotics are superior to postoperative topical antibiotics alone.
There is a need for a direct-comparison analysis of intracameral antibiotics as well as a randomized controlled trial for intracameral moxifloxacin efficacy and safety.
Dr. Jay C. Erie, a cataract surgeon at Mayo Clinic in Rochester, Minnesota, said, Placement of antibiotics inside the eye at the end of cataract surgery is strongly effective in reducing the chance of sight-threatening endophthalmitis after cataract surgery.
The most commonly used antibiotics – cefuroxime and moxifloxacin – are safe and have very low toxicity. Vancomycin, however, is associated with rare severe retinal events and probably should be avoided.
"This analysis also suggests, but does not prove, that intracameral antibiotics alone may be as effective as intracameral plus topical antibiotic drops in reducing the chance of infection after cataract surgery," added Dr. Erie, who was not involved in the study.
"The results of this study are important, as over 10 million cataract surgeries are performed worldwide every year. These results strongly support the use of intracameral antibiotics in reducing the chance of sight-threatening infections," he noted.