Eyeworld

EW CATARACT 26 December 2015 by Vanessa Caceres EyeWorld Contributing Writer surgeons as they consider intraca- meral versus topical prophylaxis. Dr. Stiverson has been part of a Kaiser Permanente study that found decreasing endophthalmitis rates after using intracameral antibiotic injections. 3,4 When surgeons decide to use intracameral antibiotics, they must consider the risk of anaphylaxis with cefuroxime, ethical issues with van- comycin, compounding concerns with cefuroxime or vancomycin, and gram-positive resistance with moxifloxacin. Dr. Stiverson thinks that intracameral antibiotics are away from fourth-generation fluoro- quinolones, such as gatifloxacin and moxifloxacin (60% compared with 81% in the 2007 survey). In white papers published in 2011 by ASCRS and the Ameri- can Academy of Ophthalmology, researchers did not yet say that in- tracameral antibiotic injections were standard of care in the U.S., but they did say that they were reviewing the evidence, Dr. Chang said. During the same session of the symposium, Kent Stiverson, MD, Kaiser Permanente, Denver, addressed concerns for ophthalmic Surgeons explore how intracameral injections, dropless drug delivery are changing cataract surgery C hanging trends in pro- phylaxis during cataract surgery were a hot topic at "Cataract Dilemmas and Controversies," a sym- posium at the 2015 ASCRS•ASOA Symposium & Congress. The symposium was sponsored by the ASCRS Cataract Clinical Committee. During the session "Intraca- meral Antibiotics/Topical Versus Dropless Cataract Surgery," David F. Chang, MD, Los Altos, Calif., discussed the results of the 2014 ASCRS member survey that focused on antibiotic prophylaxis of postop endophthalmitis after cataract sur- gery. This was a follow-up to a 2007 survey, 1 and the results were also published this year in the Journal of Cataract & Refractive Surgery. 2 More than 1,100 ASCRS mem- bers completed the 2014 survey, and 65% of respondents were from the U.S. Only 9% were from Europe, where intracameral antibiotic injec- tion prophylaxis is more common. The survey found an increasing use of intracameral antibiotics, Dr. Chang said. Nearly half (47%) of respondents were already using or soon planning to use intracameral antibiotic injection. However, of those not using them, half were concerned about the fact that there are no commercially prepared an- tibiotic injections available in the U.S.—which means they must either be mixed in the operating room or compounded by a pharmacy. This is in contrast to intracameral prophy- laxis in Europe, where a commercial formulation is available as Aprokam (cefuroxime, Thea Pharmaceuticals, Clermont-Ferrand, France). In fact, if there was a com- mercial formulation in the U.S. at a reasonable cost, nearly 84% of respondents said they would use it, Dr. Chang reported. The survey also found a shift toward the use of topical ofloxacin and ciprofloxacin (21% compared with 9% in the previous survey) and Preventing infection T he 2015 ASCRS•ASOA Symposium & Congress once again featured a symposium hosted by the Cata- ract Clinical Committee titled "Cataract Dilemmas and Controversies," which was very popular. In particular, one topic of interest is whether or not we should be using intracameral antibiotics for all of our cataract surgeries and if so, which one is ideal. Many of us sit on the fence with this topic, due to the fact that in North America there is not a readily available compounded antibiotic. However, we were lucky enough to have 3 thought leaders review data and surveys on what would be the best route to take and if we should be taking it any time soon. It is an interesting time as more options are available and we weigh the risk of endophthalmitis versus the risk of TASS or resistance. Rosa Braga-Mele, MD, MEd, FRCSC, cataract editor Cataract editor's corner of the world In the 2014 ASCRS member survey that focused on antibiotic prophylaxis of postop endophthalmitis after cataract surgery, 65% of respondents were from the U.S. Only 9% were from Europe, where intracameral antibiotic injection prophylaxis is more common. The survey also found an increase in the use of topical ofloxacin and ciprofloxacin (21% compared with 9% in the previous survey) and a decrease in the use of fourth-generation fluoroquinolones. Source: David F. Chang, MD

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