Eyeworld

67 EW RETINA October 2016 Reference 1. Schwartz SG, et al. Intracameral antibiotics and cataract surgery: Endophthalmitis rates, costs, and stewardship. Ophthalmology. 2016;123:1411–1413. because I'm afraid it may shift the lens," he said. Despite such challenges, he strongly favors the dropless ap- proach over use of topical drops alone for staving off endophthal- mitis. This is particularly true in high-risk cases. "If I had a capsular violation or a monocular patient, I would give Tri-Moxi even if I'm going to put the patient on topicals because in my opinion the best way to prevent endophthalmitis is to put the antibiotic inside the eye," Dr. Hamilton said. Considering concerns Not everyone agrees that the intraca- meral approach should be embraced for staving off endophthalmitis following cataract surgery. Andrew Schachat, MD, vice chairman, Cole Eye Institute, Cleveland Clinic, has reservations about the approach. He cited an editorial in Ophthalmology as highlighting many of his own concerns. 1 "This article summarizes for me the anxieties about doing this," he said. One such concern is cost. "Based on this analysis, we would have to treat 2,500 patients to pre- vent one (endophthalmitis) case," Dr. Schachat said. "If the drugs cost $100, then 2,500 doses would cost a quarter of a million dollars to avoid one case." There is also some risk to using these intracameral antibiotics, he pointed out. "There is some risk in general in increasing resistance by treating 2,500 people who didn't need it, when only one needed it," he said, adding that it requires huge randomized trials to teach about the role of intracameral antibiotics for endophthalmitis prophylaxis. Cur- rently, he doesn't think that there is enough data to make a decision. "For me it remains controversial whether intracameral antibiotics should be used for surgical prophy- laxis for cataract surgery," he said. Dr. Hamilton also sees the need for more research here. "I think that with time this will pan out as the way to go when we have enough data," he said. "Once [researchers] do thousands of cases, then I think we'll have more data that pushes us that way," Dr. Hamilton said. "But at this point it's all anecdotal." EW Editors' note: Drs. Hamilton and Schachat have no financial interests related to their comments. Contact information Hamilton: SHamiltonMD@comcast.net Schachat: schacha@ccf.org lioli TM IOL Delivery System Hydrophilic Coated with LubriMATRIX TM Technology with Asqelio soft hydrophobic intraocular lens TM 9 Linnell Circle, Billerica, MA 01821, U.S.A. T: +1.978.667.4500 F: +1.978.667.9778 www.astp.com Asqelio TM , lioli TM & LubriMATRIX TM are trademarks of AST Products, Inc.

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