Prophylactic antibiotics for ophthalmic surgery

doi:10.1016/0039-6257(83)90193-5

Survey of Ophthalmology

Volume 27, Issue 6, May–June 1983, Pages 353-373

https://doi.org/10.1016/0039-6257(83)90193-5 Get rights and content

Abstract

Preoperative or immediately postoperative antibiotics have been used by ophthalmic surgeons routinely as prophylaxis for postoperative endophthalmitis. The rationale for such prophylaxis, and the evidence which supports its efficacy are well founded. The optimal choice of antibiotics, however, from the standpoints of efficacy, delivery (route, dosage, and frequency of administration), adverse reactions, and cost is far less well established. This review considers these issues in the context of a critical evaluation of the pertinent literature.

References (116)

R Abel et al.
Intraocular penetration of cefazolin sodium in rabbits
Am J Ophthalmol
(1974)
M.D. Abelson et al.
Normal conjunctiva wound edge flora of patients undergoing uncomplicated cataract extractions
Am J Ophthalmol
(1973)
H.F. Allen
Prevention of postoperative endophthalmitis
Ophthalmology
(1978)
W.D. Anderson
Prophylactic antibiotics and endophthalmitis in Vietnam
Am J Ophthalmol
(1973)
N Ando et al.
Fungal flora of the conjunctival sac
Am J Ophthalmol
(1982)
R.H. Aronstam
Pitfalls of prophylaxis. Alteration of postoperative infection by penicillin-streptomycin
Am J Ophthalmol
(1964)
G.A. Ayliffe et al.
Postoperative infections with pseudomonas aeruginosa in an eye hospital
Lancet
(1966)
G.L. Boyle et al.
Intraocular penetration of sodium cephalothin in man after subconjunctival injection
Am J Ophthalmol
(1972)
R.P. Burns
Postoperative infections in an ophthalmologic hospital
Am J Ophthalmol
(1959)
E Cooper
A note on preoperative eye cultures
Am J Ophthalmol
(1935)

A.J. Flach

Chloramphenicol and aplastic anemia (correspondence)

Am J Ophthalmol

(1982)

F.P. Furgiuele

Penetration of gentamicin into the aqueous humor of human eyes

Am J Ophthalmol

(1970)

I Givner

Neisseria catarrhalis endophthalmitis; report of case with complete recovery

Am J Ophthalmol

(1949)

J.S. Guyton et al.

Oral use of prophylactic sulfadiazine for cataract extractions

Am J Ophthalmol

(1943)

T.K. Hunt

Surgical wound infection: A overview

Am J Med

(1981)

G.G. Jackson

Considerations of antibiotic prophylaxis in non-surgical high risk patients

Am J Med

(1981)

A.E. Kolker et al.

Prophylactic antibiotics and postoperative endophthalmitis

Am J Ophthalmol

(1967)

I.H. Leopold et al.

Postoperative intraocular infections

AM J Ophthalmol

(1960)

D Locatcher-Khorazo

The effect on the ocular bacterial flora of local treatment with chloromycetin (chloramphenicol), terramycin or penicillin-streptomycin ophthalmic ointments in preoperative cataract cases and miscellaneous infections

Am J Ophthalmol

(1953)

D Locatcher-Khorazo et al.

Eye infections following cataract extraction

Am J Ophthalmol

(1956)

S.D. McPherson et al.

Aqueous humor assays of subconjunctival antibiotics

Am J Ophthalmol

(1968)

M.A. Mosier et al.

Fungal endophthalmitis following intraocular lens implantation

Am J Ophthalmol

(1977)

K.F. Nassif et al.

Factors that influence the efficacy of topical gentamicin prophylaxis for experimental pseudomonas keratitis

Am J Ophthalmol

(1982)

M Neveu et al.

Prophylaxis and treatment of endophthalmitis

Am J Ophthalmol

(1959)

R.L. Nichols

Use of prophylactic antibiotics in surgical practice

Am J Med

(1981)

R Abel et al.

Postoperative bacterial endophthalmitis. Section I

Ann Ophthalmol

(1976)

R Abel et al.

Postoperative bacterial endophthalmitis. Section III

Ann Ophthalmol

(1976)

M.R. Allansmith et al.

The meaning of preoperative cultures in ophthalmology

Tr Am Acad Ophthalmol Otolaryngol

(1969)

M.R. Allansmith et al.

Concomitance of bacteria in various areas of the eye

Arch Ophthalmol

(1969)

M.R. Allansmith et al.

The diagnostic value of anterior chamber paracentesis in 14 cases of postoperative endophthalmitis

Tr Am Ophthalmol Soc

(1970)

H.F. Allen et al.

Bacterial endophthalmitis after cataract extraction

Arch Ophthalmol

(1964)

H.F. Allen

discussion in Burns RP, Oden M: Antibiotic prophylaxis in cataract surgery

Trans Am Ophthalmol Soc

(1972)

H.F. Allen et al.

Bacterial endophthalmitis after cataract extraction. II. Incidence in 36,000 consecutive operations with special reference to preoperative topical antibiotics

Arch Ophthalmol

(1974)

T Axenfeld

The Bacteriology of the Eye

M Barza et al.

Penetration of ocular compartments by penicillins

Surg Ophthalmol

(1973)

M Barza

A critique of animal models in antibiotic research

Scand J Infect Dis Suppl

(1978)

M Barza

Factors affecting the intraocular penetration of antibiotics

Scand J Infect Dis Suppl

(1978)

J.L. Baum et al.

Treatment of postcataract endophthalmitis with periocular and systemic antibiotics and corticosteroids

Tr Am Ophthalmol Otolaryngol

(1976)

C.B. Begg et al.

Participation of community hospitals in clinical trials

N Engl J Med

(1982)

P.S. Binder et al.

The effect of chronic administration of a topical antibiotic on the conjunctival flora

Ann Ophthalmol

(1975)

P.S. Binder et al.

Postoperative bacterial endophthalmitis. Section II

Ann Ophthalmol

(1976)

P.S. Binder et al.

Continuous wear hydrophilic lens. Prophylactic topical antibiotics

Arch Ophthalmol

(1976)

R.P. Burns et al.

An experimental model for evaluation of human conjunctivitis and topical antibiotic therapy: Comparison of gentamicin and neomycin

Can J Ophthalmol

(1968)

R.P. Burns et al.

Antibiotic prophylaxis in cataract surgery

Trans Am Ophthalmol Soc

(1972)

R.P. Burns

Effectiveness study of antibiotics

A Callahan

Effect of sulfonamides and antibiotics on panophthalmitis complicating cataract extraction

Arch Ophthalmol

(1953)

L Cason et al.

Bacteriology of the eye 1. Normal flora

Arch Ophthalmol

(1954)

J.R. Cassady

Prophylactic subconjunctival antibiotics following cataract extraction

Am J Ophthalmol

(1967)

T.H.F. Chalkey et al.

An evaluation of prophylactic subconjunctival antibiotic injection in cataract surgery

Am J Ophthalmol

(1967)

T Chalkey et al.

Prophylactic intraocular antibiotics in cataract surgery

Trans Am Ophthalmol Soc

(1971)

Cited by (76)

Ion Exchange Nanoparticles for Ophthalmic Drug Delivery
2020, Bioconjugate Chemistry
We report here on ion-exchange polymeric nanoparticles from a linear copolymer of maleic anhydride methyl vinyl ether esterified with 30% octadecanol. The side chains for the polymer structure were optimized through metadynamics simulations, which revealed the use of octadecanol esters generates ideal free energy surfaces for drug encapsulation and release. Nanoparticles were synthesized using a solvent evaporation-precipitation method by mixing the polymer solution in acetone into water; upon acetone evaporation, a nanodispersion with an average particle size of ∼150 nm was obtained. Gentamicin sulfate, possessing five amino groups, was spontaneously entrapped in the nanocarrier by ionic interactions. Encapsulation efficiency increases significantly with the increase in pH and ionic strength. In vivo results demonstrate high gentamicin (GM) content in the enteric chamber (AUC 8207 ± 1334 (μg min)/mL) compared to 3% GM solution (AUC 2024 ± 438 (μg min)/mL). The formulation was also able to significantly extend the release of gentamicin when applied to rabbit cornea. These anionic nanoparticles can be used for extended-release of other cationic drugs.
Phakic penetrating keratoplasty
2008, Corneal Surgery: Theory Technique and Tissue: Fourth Edition
Patterns of perioperative prophylaxis for cataract surgery in Canada
2007, Canadian Journal of Ophthalmology
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, χ²). As case volume increased, surgeons were more likely to use intracameral antibiotics (p = 0.0185, exact Mantel-Haenszel χ² test) and postoperative topical antibiotics (p = 0.0044, exact Mantel-Haenszel χ² test), and less likely to use subconjunctival antibiotics (p = 0.0011, exact Mantel-Haenszel χ²). As time in practice decreased, surgeons were more likely to use postoperative topical antibiotics (p = 0.0319, exact Mantel-Haenszel χ² 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.
Interpretation: 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.
Contexte: Cette étude a pour objet de documenter les méthodes prophylactiques utilisées en chirurgie de la cataracte au Canada.
Méthodes: Un sondage fait par plate-forme en ligne, sous anonymat et protégé par un mot de passe, a été adressé par courriel ou par la poste, entre novembre 2004 et janvier 2005, à 800 ophtalmologistes exerçant au Canada.
Résultats: Parmi les 239 répondants (taux de réponse de 30%), 216 pratiquaient la chirurgie de la cataracte. Parmi ces derniers, 99% préféraient la phacoémulsification: 78% utilisaient des antibiotiques topiques avant l’opération, notamment la moxifloxacine (32%). Pendant l’opération, 98% utilisaient l’anti-infectieux pour la peau providone-iode; 15%, des antibiotiques intracaméraux; et 11%, des antibiotiques sous-conjonctivaux. Après l’opération, 97% utilisaient des antibiotiques topiques, notamment la moxifloxacine (30%), et 1% utilisaient couramment des antibiotiques systémiques postopératoires. Après perte du vitrée, 39% ont modifié le schéma prophylactique et 68% de ces derniers ajoutèrent des antibiotiques systémiques. Le taux moyen rapporté d’endophtalmie postopératoire survenue dans l’année précédente était de 0,088%. Les ophtalmologistes en communauté étaient plus enclins à utiliser des antibiotiques topiques avant l’opération (p = 0,0016, χ²). Avec l’accroissement du volume des cas, les chirurgiens étaient plus enclins à utiliser des antibiotiques intracaméraux (p = 0,0185, test Mantel-Haenszel exact χ²) et des antibiotiques topiques postopératoires (p = 0,0044, test Mantel-Haenszel exact χ²), et ils étaient moins enclins à utiliser des antibiotiques sous-conjonctivaux (p = 0,0011, test Mantel-Haenszel exact χ²). Avec la réduction du temps en pratique, les chirurgiens étaient plus enclins à utiliser des antibiotiques topiques postopératoires (p = 0,0319, test Mantel-Haenszel exact χ²). On a associé aux régions des provinces l’utilisation de l’antibiotique topique préopératoire (p = 0,0076, test exact de Fisher), de l’antibiotique intracaméral (p = 0,0314, test exact de Fisher) et de l’antibiotique sousconjonctival (p = 0,0373, test exact de Fisher). Il n'y avait pas d’association entre le taux rapporté d’endophtalmie postopératoire et l’utilisation de toute forme d’antibiotique durant l’opération.
Interprétation: Les méthodes prophylactiques ordinairement utilisées en chirurgie de la cataracte au Canada comprennent l’anti-infectieux providone-iode et les antibiotiques topiques péri-opératoires. Les antibiotiques intracaméraux et sous-jonctivaux ne sont pas des méthodes prophylactiques couramment utilisées. Les antibiotiques systémiques sont utilisés en prophylaxie par un sous-ensemble d’ophtalmologistes pour les cas compliqués par la perte du vitrée.
Endophthalmitis: Pathogenesis and antibiotic prophylaxis
2005, Journal Francais d'Ophtalmologie
L’endophtalmie postopératoire est une des complications les plus redoutables et redoutées de la chirurgie de la cataracte. Cette revue de la littérature se propose d’étudier l’étiopathogénie de ces endophtalmies et les arguments pour la décision d’antibioprophylaxie. Actuellement, 0,07 % à 0,32 % des chirurgies réglées de la cataracte présentent une complication infectieuse. La connaissance parfaite des signes cliniques est indispensable. Les microorganismes prédominants sont les bactéries à Gram positif, plus particulièrement le Staphylococcus epidermidis. La majorité de ces bactéries proviennent du patient lui-même. Leur adhésion aux implants intraoculaires est un facteur étiologique reconnu. Le bénéfice de l’antibioprophylaxie au cours de la chirurgie de la cataracte n’a pas encore été démontré, la faible fréquence de l’endophtalmie rendant difficile la réalisation d’études en double insu sur des cohortes nécessairement très importantes. Les critères de choix ainsi que les quatre voies possibles d’administration (topique, sous-conjonctivale, liquide d’irrigation, systémique) sont passés en revue.
Postoperative endophthalmitis is still one of the most fearsome complications of cataract surgery. The present review's aims are to study the etiology and pathogenesis of endophthalmitis and the criteria for antibiotic prophylaxis. Endophthalmitis prevalence is 0.07%-0.32% in cataract surgery. The clinical presentation needs to be perfectly known, even if none of the signs is pathognomonic. Bacteria predominantly cultured in postoperative endophthalmitis are Gram-positive, especially Staphylococcus epidermidis. Most of the bacteria come from the patient. Bacterial adhesion to intraocular lenses (IOLs) takes place during their implantation, a prominent etiological factor. Polypropylene was the first biomaterial that proved this relation of cause and effect between bacterial adhesion and endophthalmitis. The benefit of antibiotic prophylaxis during cataract surgery has yet not been proven, since the low prevalence of endophthalmitis makes controlled studies with a large cohort difficult. The criteria and the four possible administration approaches (topical, subconjunctival, irrigation liquid, systemic) are analyzed.
Comparison of topical tobramycin-dexamethasone with dexamethasone-neomycin- polymyxin and neomycin-polymyxin-gramicidin for control of inflammation after cataract surgery: Results of a multicenter, prospective, three-arm, randomized, double-masked, controlled, parallel-group study
2004, Clinical Therapeutics
Intraocular inflammation is typically treated with a combination of anti-inflammatory and anti-infective drugs. Tobramycin—dexamethasone (TD) has not been associated with any serious adverse events, indicating good tolerability.
The aims of this study were the following: (1) to demonstrate noninferiority of TD compared with dexamethasone—neomycin—polymyxin (DNP) in terms of anti-inflammatory efficacy, (2) to compare the anti-inflammatory efficacy of TD and DNP with that of a “placebo” control (antibiotic without anti-inflammatory agent), and (3) to provide additional safety data on TD.
This prospective, double-masked, parallel-group study was conducted at 22 ophthalmology clinics across Europe and Brazil. Patients aged > 18 years undergoing cataract surgery were randomly assigned, in a 2: 2: 1 ratio, to receive tobramycin 3 mg/mL plus dexamethasone 1 mg/mL, dexamethasone 1 mg/mL plus neomycin sulfate 3500 IU/mL plus polymyxin B sulfate 6000 IU/mL, or neomycin sulfate 3500 IU/mL plus polymyxin B sulfate 7500 IU/mL plus gramicidin 20 μg/mL. All treatments were given as 1 drop instilled in the operated eye QID for 21 days. The primary efficacy end point, intraocular inflammation (determined using the sum of scores on anterior chamber cells and aqueous flare), was assessed at days 3, 8, 14, and 21 after surgery.
A total of 271 patients were enrolled (158 women, 113 men; age range 42–90 years) (TD, 104 patients; DNP, 110 patients; and neomycin-polymyxin-gramicidin [NPG], 57 patients). Intraocular inflammation was similar in the TD and DNP groups at all time points. At days 8, 14, and 21, inflammation scores were significantly lower with TD than with NPG (all, P < 0.05). At day 8, the inflammation score was significantly lower with DNP than with NPG (P < 0.05). A greater number of patients receiving NPG experienced treatment-related ocular allergic reactions compared with patients receiving TD (P < 0.05). One patient receiving TD (1.0%) and 5 given NPG (9.0%) were withdrawn due to ocular allergic reactions. None of the patients experienced an increase in intraocular pressure ≥10 mm Hg from baseline.
In this study of patients undergoing cataract surgery combination therapy with TD was noninferior to DNP and was well tolerated.
Aqueous humor levels of topically applied levofloxacin, norfloxacin, and lomefloxacin in the same human eyes
2003, Journal of Cataract and Refractive Surgery
To assess the relative penetration of topical eyedrops of 3 fluoroquinolones into the aqueous humor in human eyes.
Department of Ophthalmology, Sano-Kosei Hospital, Sano, Japan.
Fifty-nine cataract patients (36 women, 23 men) received 3 drops each of levofloxacin 0.5%, norfloxacin 0.3%, and lomefloxacin 0.3% in the same eye at 15-minute intervals beginning 90 minutes before cataract surgery. At the beginning of surgery, 50 μL of aqueous humor was aspirated from the anterior chamber and stored at −80°C until analyzed. The drug concentrations in the samples were analyzed using high-performance liquid chromatography.
Five patients were excluded from the study because their sample volumes were insufficient. Norfloxacin was detected in 3 patients; the mean aqueous humor level was 0.10 μg/mL ± 0.02 (SD). Levofloxacin was detected in all cases; the mean aqueous humor level was 0.60 ± 0.28 μg/mL (n = 54). Lomefloxacin was not detected in 10 patients; the mean aqueous humor level was 0.23 ± 0.11 μg/mL (n = 44).
Topically applied levofloxacin had better penetration into the aqueous humor than lomefloxacin and norfloxacin.

View all citing articles on Scopus

View full text

ReviewProphylactic antibiotics for ophthalmic surgery

Abstract

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Lancet

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Med

Am J Med

Am J Ophthalmol

AM J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Med

Postoperative bacterial endophthalmitis. Section I

Ann Ophthalmol

Postoperative bacterial endophthalmitis. Section III

Ann Ophthalmol

The meaning of preoperative cultures in ophthalmology

Tr Am Acad Ophthalmol Otolaryngol

Concomitance of bacteria in various areas of the eye

Arch Ophthalmol

The diagnostic value of anterior chamber paracentesis in 14 cases of postoperative endophthalmitis

Tr Am Ophthalmol Soc

Bacterial endophthalmitis after cataract extraction

Arch Ophthalmol

discussion in Burns RP, Oden M: Antibiotic prophylaxis in cataract surgery

Trans Am Ophthalmol Soc

Bacterial endophthalmitis after cataract extraction. II. Incidence in 36,000 consecutive operations with special reference to preoperative topical antibiotics

Arch Ophthalmol

The Bacteriology of the Eye

Penetration of ocular compartments by penicillins

Surg Ophthalmol

A critique of animal models in antibiotic research

Scand J Infect Dis Suppl

Factors affecting the intraocular penetration of antibiotics

Scand J Infect Dis Suppl

Treatment of postcataract endophthalmitis with periocular and systemic antibiotics and corticosteroids

Tr Am Ophthalmol Otolaryngol

Participation of community hospitals in clinical trials

N Engl J Med

The effect of chronic administration of a topical antibiotic on the conjunctival flora

Ann Ophthalmol

Postoperative bacterial endophthalmitis. Section II

Ann Ophthalmol

Continuous wear hydrophilic lens. Prophylactic topical antibiotics

Arch Ophthalmol

An experimental model for evaluation of human conjunctivitis and topical antibiotic therapy: Comparison of gentamicin and neomycin

Can J Ophthalmol

Antibiotic prophylaxis in cataract surgery

Trans Am Ophthalmol Soc

Effectiveness study of antibiotics

Effect of sulfonamides and antibiotics on panophthalmitis complicating cataract extraction

Arch Ophthalmol

Bacteriology of the eye 1. Normal flora

Arch Ophthalmol

Prophylactic subconjunctival antibiotics following cataract extraction

Am J Ophthalmol

An evaluation of prophylactic subconjunctival antibiotic injection in cataract surgery

Am J Ophthalmol

Prophylactic intraocular antibiotics in cataract surgery

Trans Am Ophthalmol Soc

Review
Prophylactic antibiotics for ophthalmic surgery