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EW CATARACT 24 January 2015 as antibiotic eye drops, topical povi- done-iodine for lids and lashes, and surgical draping. They urged pro- longing the contact time of povidone-iodine to lids, lashes, and the conjunctival cul-de-sac in patients who are known to have or are at risk for MRSA. Currently, the strongest ev- idence regarding the potential efficacy for antibiotic prophylaxis surrounding cataract surgery is represented by an intracameral bolus injected at the conclusion of surgery. Furthermore, the authors encouraged the implementation of universal precautions such as frequent hand washing and disinfec- tion as highly effective measures for limiting the spread of S. aureus from person to person or via an infected medium. Final thoughts "Since conducting this review, new studies have emerged revealing changes in antibiotic susceptibilities and MRSA trends. It is therefore very important for clinicians to stay informed," Dr. Mah said. "We have to take full advantage of the recommendations from the peer-re- viewed literature, for instance the overwhelming evidence in favor of 2–5 minutes of contact with 5% povidone-iodine solution prior to surgical interventions to squash infections as well as the evidence in favor of proper draping and cleaning of the lashes. "These methods are going to be important in reducing and eradicat- ing MRSA," he said. EW Reference Mah F, Davidson R, Holland E, et al. Current knowledge about and recommendations for ocular methicillin-resistant Staphylococcus. J Cataract & Refractive Surgery. 2014:40(11); 1894–1908. Editors' note: Drs. Mah and Starr have no financial interests related to their comments. Contact information Mah: Mah.Francis@scrippshealth.org Starr: cestarr@med.cornell.edu by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer "We need to curb the tide of MRSA and have efficacious meth- ods for controlling its spread. It is important that we are cognizant of these methods and use what we have available to control infections," said Dr. Mah, director of cornea and external disease, and co-director of refractive surgery, Scripps Clinic, La Jolla, Calif. "Good medical practices can reduce infections caused by this highly resistant bug and help to eradicate it." The review process The authors carried out a review of the current literature, focusing on relevant issues for ophthalmologists. "Our goal was for ophthalmol- ogists to understand the prevalence, etiology, and risk factors associated with MRSA infections," Dr. Starr said. The article opens with a discus- sion of the historical development of S. aureus resistance to methicillin, which was itself developed to treat penicillin-resistant S. aureus, and the mutations that enable these pathogens to survive and thrive in an otherwise hostile environment. It discusses hospital- versus communi- ty-acquired MRSA, citing increased MRSA cases in individuals with no known risk factors for MRSA coloni- zation. The authors examined MRSA epidemiology as it relates to oph- thalmology, identifying 20% of the general population as S. aureus carri- ers. They then reviewed prophylactic measures, such as patient screening for MRSA prior to surgery, empha- sizing that known MRSA patients require extra precautions and need to be identified through electronic records or by highlighting the pa- tient's chart. The authors discussed treatment options for MRSA-in- duced blepharitis, conjunctivitis, keratitis, and endophthalmitis and distinguish between systemic and ocular antibiotic therapy, in which they consider antibiotic dosage and concentration. They also examined antibiotic sensitivities for MRSA and the development of resistant strains at ophthalmic dosages. Finally, the authors discussed recommendations and strategies on how to still the rise of MRSA infections by using modalities such Paper examines the current state of MRSA knowledge and reminds clinicians to exercise good clinical practice T he increasingly relevant issue of methicillin-resis- tant Staphylococcus aureus (MRSA) was the topic cho- sen by the ASCRS Cornea Clinical Committee for its review "Current knowledge about and recommendations for ocular methi- cillin-resistant Staphylococcus aureus" that appeared in the Nov. 2014 issue of the Journal of Cataract & Refractive Surgery. The paper reviewed the medical literature for studies related to MRSA in ophthalmology, to support clinicians in stemming the tide of rising MRSA infections in their patients. Francis S. Mah, MD, Richard Davidson, MD, Edward J. Holland, MD, John Hovanesian, MD, Thomas John, MD, John Kanellopoulos, MD, Neda Shamie, MD, Christopher Starr, MD, David Vroman, MD, and Terry Kim, MD, conducted the review for the ASCRS Cornea Clinical Committee. The authors describe MRSA as the latest and, to date, toughest combatant in the infectious disease arms race. "MRSA used to be thought of as a hospital-based pathogen, but the reality is that this superbug is everywhere, and every ophthalmic surgical patient is at a potential risk of infection. As MRSA resistance increases, our antibiotic choices get narrower so we have to take measures to prevent infection," said Dr. Starr, associate professor of ophthalmology, director of refractive surgery, and director of the cornea, cataract, and re- fractive surgery fellowship, Weill Cornell Medical Center, New York Presbyterian Hospital, New York. Dr. Starr is a co-author of the paper. Although S. aureus is a common culprit of bacterial keratitis, reports of postoperative MRSA infections in clear corneal phacoemulsification wounds and MRSA keratitis follow- ing LASIK and PRK are of special concern and suggest its increasing prevalence. Review offers extensive ocular MRSA overview

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