EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78710
May 2012 Perioperative pharmacology February 2011 EW FEATURE 37 because things have been advancing together. I do think that the evi- dence is stronger for intracamerals than for topical, though." Intracameral injections Ever since a 2006 multicenter collab- orative study by the European Society of Cataract & Refractive Sur- geons (ESCRS) showed conclusively that the concept of intracameral in- jections of antibiotics reduces the risk of endophthalmitis more effec- tively than topical antibiotics alone, U.S. surgeons have begun to adopt the practice, albeit often with a dif- ferent drug than used in the popular study. Intracameral injections of an- tibiotics for prophylaxis in cataract surgery are off-label, like most drug uses in ophthalmology. "The ESCRS study proved that intracameral antibiotics work very well at reducing infection rates, but the problem was that there was no comparison of one drug to another," said Steve A. Arshinoff, M.D., clini- cal instructor of ophthalmology, University of Toronto. "It only proved the concept." In the ESCRS study, intracam- eral Ceftin (cefuroxime, Glaxo- SmithKline, Middlesex, U.K.) was used. "The reason cefuroxime has not gained popularity here is that it has to be diluted and mixed, and there's this large concern about improper dilution and developing toxicity and toxic anterior segment syndrome (TASS)," said Samuel Masket, M.D., clinical professor of ophthalmology, Jules Stein Eye Institute, David Gef- fen School of Medicine, University of California, Los Angeles. Also, cefuroxime doesn't cover the most common pathogen that leads to endophthalmitis—Staphylococcus epidermidis. In the December 2011 Journal of Cataract & Refractive Surgery, Dr. Arshinoff and his colleagues studied whether prophylactic intracameral antibiotics would lessen the inci- dence of endophthalmitis during sequential bilateral cataract surgery. The researchers reviewed relevant literature and surveyed members of the International Society of Bilateral Cataract Surgeons and discovered that the bilateral approach to sur- gery did not increase the risk of en- Whether you're just beginning or experienced in cataract and refractive surgery, ASCRS is the professional society that's right for every stage of your career. Young Ophthalmologists & Residents When you're the newest member of the team, things can be a little overwhelming. ASCRS can help with the transition. Our monthly Journal of Cataract and Refractive Surgery, Annual Symposium, and online educational initiatives work to continuously augment your formal training. Through them you'll meet like-minded young ophthalmologists facing similar challenges and concerns, along with those who've successfully navigated the waters and can provide the guidance to answer your clinical, financial, and practice management questions. For young practitioners, ASCRS is where the anterior segment ophthalmology community comes together. ASCRS offers U.S. residents and fellows an unmatched opportunity to experience anterior segment ophthalmology beyond your training program—all at no cost! Resident and fellow membership, which includes the Annual Symposium, is free during your training. ASCRS makes it easy to gain real-world experience and education with no added cost. Join ASCRS today! The Society for Surgeons AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 4000 Legato Road, Suite 700, Fairfax, VA 22033 • 703-591-2220 • www.ASCRS.org dophthalmitis. They also concluded that the risk of post-op endoph- thalmitis was significantly reduced by use of intracameral antibiotics. In Europe, for example, they found a 0.3% incidence without prophylac- tic intracameral antibiotics and a 0.05% occurrence with their use in unilateral cataract surgery. Dr. Arshinoff mixes 0.2 ccs of 300 micrograms of Vigamox (moxi- floxacin hydrochloride ophthalmic solution, Alcon, Fort Worth, Texas) with balanced salt solution (BSS, Alcon). continued on page 38 An ASCRS Membership For every stage of your career