Eyeworld

30 | EYEWORLD | DECEMBER 2021 ASCRS NEWS References 1. Barry P, et al. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a Europe- an multicenter study. J Cataract Refract Surg. 2006;32:407–410. 2. Chang DF, et al. Prophylaxis of postoperative endophthalmitis following cataract surgery: re- sults of the 2007 ASCRS member survey. J Cataract Refract Surg. 2007;33:1801–1805. 3. Chang DF, et al. Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2014 ASCRS member survey. J Cataract Refract Surg. 2015;41:1300–1305. 4. Chang DF, Rhee DJ. Antibiotic prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the 2021 ASCRS member survey. J Cataract Refract Surg. 2021. Online ahead of print. 5. Herrinton LJ, et al. Compara- tive effectiveness of antibiotic prophylaxis in cataract surgery. Ophthalmology. 2016;123:287– 294. 6. Witkin AJ, et al. Vancomy- cin-associated hemorrhagic occlusive retinal vasculitis: clinical characteristics of 36 eyes. Ophthalmology. 2017;124:583– 595. 7. Haripriya A, et al. Endophthal- mitis reduction with intracamer- al moxifloxacin in eyes with and without surgical complications: Results from 2 million consecu- tive cataract surgeries. J Cataract Refract Surg. 2019;45:1226–1233. by David F. Chang, MD T he results of the ESCRS intraocular cefuroxime prophylaxis randomized clinical trial (RCT) were first report- ed in 2006. 1 This landmark study demonstrated the safety and efficacy of intracameral cefuroxime injection and led to the European Medicines Agency (EMA), but not U.S. FDA, approval of a commercial cefuroxime solution. Fifteen years following publication of this study, the necessity and method of intraoc- ular antibiotic prophylaxis remains controver- sial, in large part due to the lack of approved commercial antibiotic formulations in most countries. To assess the effect of the ESCRS RCT on antibiotic prophylaxis practice patterns, the ASCRS Cataract Clinical Committee conducted a member survey in 2007. 2 Of the more than 1,300 respondents, 30% were using intraocu- lar antibiotic prophylaxis. Half of them placed the antibiotic in the irrigation bottle, and half directly injected the antibiotic into the anterior chamber (AC). Vancomycin was employed by 60% of these cataract surgeons and a cepha- losporin by 23%. A significant shift in practice pattern was noted when we repeated the ASCRS member survey in 2014. 3 With 1,147 total re- spondents, the percentage of surgeons employ- ing intraocular antibiotic prophylaxis increased from 30% to 50%. Furthermore, most of them (84%) were now directly injecting intracameral antibiotic into the AC, as opposed to placing antibiotic in the irrigating solution (16%). The antibiotic preference for those using direct intra- ocular injection was divided among cefuroxime (26%), moxifloxacin (33%), and vancomycin (37%). Following another 7-year interval, we repeated the survey earlier this year. To allow comparison of trends over time, we used iden- tically worded questions from the two earlier surveys whenever possible. A link to the anon- ymous, 19-question online survey was emailed to all ASCRS members worldwide, and it was completed by 1,205 respondents. Of these, 76% were from the United States, 8% from Latin America/Mexico, 6% from Europe, 7% from Asia/Australia, and 3% from Canada. This was comparable to the total number of respondents for the 2007 and 2014 surveys. Survey findings have been published as a special report in the Journal of Cataract & Refractive Surgery. 4 Results The percentage of respondents using preoper- ative (73%) and postoperative (86%) topical antibiotic prophylaxis decreased compared to 90% and 97%, respectively, in the two prior surveys (Table 1). Consistent with the earlier surveys, approximately half of those prescribing preoperative antibiotic drops initiated them 3 days before surgery. The rest initiated topical antibiotic prophylaxis either on the day of or the day prior to surgery. Several studies have reported no additional benefit to topical anti- biotics if intraocular antibiotic prophylaxis was employed. 5 Among those using intracameral antibiotic prophylaxis in the 2021 survey, ap- proximately 25% did not prescribe any topical antibiotic postoperatively. This is significant because it means that using intracameral antibi- otic instead of topical antibiotic is not violating some consensus "standard of care." Of those respondents prescribing postoperative topical antibiotics, approximately 70% discontinued them after 1 week in all three surveys, while the remainder continued them for several weeks postoperatively. There was virtually no change in topical antibiotic preferences compared to 2014. Fluo- roquinolones accounted for 90% of the topical antibiotics used; 57% preferred gatifloxacin or moxifloxacin, 25% preferred ofloxacin or ciprofloxacin, and 9% preferred besifloxacin. However, this represented a marked shift from 2007 when 9 times as many surgeons preferred gatifloxacin or moxifloxacin to the two earlier generation fluoroquinolones. There was a steady increase in the adoption of IC antibiotic during three survey timepoints (Table 1); two-thirds of surgeons employed this in 2021, compared to 50% in 2014 and 30% in 2007. The majority (95%) are now direct- ly injecting the antibiotic into the AC versus placing it in the infusion bottle (5%). Com- pared to 2007, there was a four-fold increase in the overall number of respondents directly injecting antibiotic into the AC at the end of surgery (63% vs. 16%). Of these respondents, 38% started doing so within the last 2 years. The 2021 ASCRS survey on antibiotic prophylaxis for cataract surgery

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