Eyeworld

18 | EYEWORLD | SEPTEMBER 2022 ASCRS NEWS study is consistent with a prior study at AECS of 335,000 consecutive phacoemulsification cases (0.01%). 4 There was no difference in proportions of phacoemulsification and manual small inci- sion surgery (MSICS) between the two groups, with Groups 1 and 2 having 29,097 (51%) and 12,950 (48%) MSICS cases and 27,454 (49%) and 15,061 (52%) phacoemulsification cases, respectively (P=0.77). The rates of posterior capsular rupture and zonular dialysis were <1.5%, without a difference between the two groups. The study's findings demonstrate that adopting the four Western OR protocols did not lower endophthalmitis rates following cataract surgery as compared to AECS' standard pro- tocols. Importantly, despite having multiple patients in the room and reusing of surgical instruments, phacoemulsification tubing, and surgical gowns, postoperative endophthalmitis rates at AECS (0.006%) were lower than the rate reported in the U.S. by the Intelligent Research in Sight (IRIS) Registry (0.04%). 8 AECS regularly monitors intraoperative and postoperative surgical outcomes through its electronic clinical registry. By critically eval- uating the impact of each step of its surgical protocols and the necessity of each item in the OR, AECS can offer cost-effective ophthalmic surgery without jeopardizing patient safety. Of note, all patients in this study received intraca- meral moxifloxacin prophylaxis. The findings from this study and others 7,9,10 demonstrate the effectiveness of intracameral antibiotics even in the setting of routinely reusing supplies, medi- cations, surgical devices, and OR attire. In the U.S., we are strictly prohibited from reusing surgical gowns and gloves, or from having more than one patient in the operating room. The risk of microbial cross-contamina- tion is considered high enough that repeatedly violating these policies would lead to closure of the surgical facility. Our study, involving more than 85,000 consecutive patients, found no dif- ference in endophthalmitis rate with or without taking these precautions. This challenges the necessity of our zero-tolerance prohibition of these four OR policies routinely employed at AECS. Because of the substantial economic and environmental cost of needless surgical waste, we should continue to study other OR policies and regulations that may be unnecessary for ophthalmic surgery. Editors' note: Dr. Shukla is chair of the EyeSustain Editorial Board. Dr. Chang is chair of the EyeSustain Medical Advisory Board. References continued 7. Haripriya A, et al. Changing operating room practices: the effect on postoperative endoph- thalmitis rates following cataract surgery. Br J Ophthalmol. 2022. Online ahead of print. 8. Pershing S, et al. Endophthal- mitis after cataract surgery in the United States: A report from the Intelligent Research in Sight Registry, 2013–2017. Ophthalmol- ogy. 2020;127:151–158. 9. Ravindran RD, et al. Incidence of post-cataract endophthal- mitis at Aravind Eye Hospital: outcomes of more than 42,000 consecutive cases using standardized sterilization and prophylaxis protocols. J Cataract Refract Surg. 2009;35:629–636. 10. Haripriya A, et al. En- dophthalmitis reduction with intracameral moxifloxacin prophylaxis: Analysis of 600000 surgeries. Ophthalmology. 2017;124:768–775. Contact Chang: dceye@earthlink.net Shukla: ag2965@cumc.columbia.edu continued from page 17 "Importantly, despite having multiple patients in the room and reusing of surgical instruments, phacoemulsification tubing, and surgical gowns, postoperative endophthalmitis rates at AECS were lower than the rate reported in the U.S. by the Intelligent Research in Sight (IRIS) Registry."

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