EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1529000
WINTER 2024 | EYEWORLD | 43 C Relevant disclosures DelMonte: None Epitropoulos: None during surgery, despite a known reaction to this medication systemically." Dr. DelMonte routine- ly uses intracameral moxifloxacin in every pa- tient and thinks this is the best way to prevent vision-compromising complications, and the risk of a reaction is exceedingly low. Occasionally, he'll have a patient bring up an antibiotic aller- gy in the OR, and the nurse may ask if he still wants to use moxifloxacin in the eye. "Often I say yes, and I describe to the patient why, and most of the time, they have no problem with it." Occasionally, he has a patient with a lido- caine allergy, Dr. DelMonte said. Most of them say it was used during a dental procedure, and they had cardiac issues after injected lidocaine. Usually, it's because it was right in the blood- stream, which isn't the same for ophthalmic surgery. "I routinely use lidocaine intracameral- ly inside the eye at the beginning of a procedure to help with anesthesia," he said. "I tell the managed by thoroughly washing the betadine off after the procedure. It is so valuable in preventing endophthalmitis that I think the risk of a small local reaction outweighs the risk of endophthalmitis." Alternatives to steroids, such as NSAIDs, and alternatives to betadine, such as chlorhexi- dine, can be used in place of these medications, but Dr. DelMonte said he tries to use the best available product and educates the patients on why he chooses this path. "When discussing allergies to medications and products used inside the eye, I explain to the patient that the intraocular space is an 'immune privileged' space, meaning medications or products used intraocularly during surgery do not necessarily illicit the same response that a medication used orally or on other parts of the body might," he said. "This is also very import- ant when explaining to patients why I might recommend using an antibiotic intracamerally continued on page 44 Dr. DelMonte injects intracameral moxifloxacin at the end of cataract surgery to prevent endophthalmitis. He prefers to use intracameral antibiotics even in cases of a reported systemic allergy to a similar medication due to the unique immune response inside the eye and the known benefit of this practice. Source: Derek DelMonte, MD