Eyeworld

EW CATARACT 74 January 2017 by Liz Hillman EyeWorld Staff Writer continued growth forward. ASCRS is a phenomenal organization already for education and advocacy," said the council's chairman, Douglas Rhee, MD, Department of Oph- thalmology and Visual Sciences, University Hospitals, Cleveland. "It has been a forum for the discussion of research … but I think one of the next steps in the evolution of the or- ganization is to initiate and facilitate research that will change the way we practice ophthalmology. One of the long-term questions that has been out there has … to do with the prophylactic use of antibiotics after cataract surgery." As Bonnie Henderson, MD, clinical professor of ophthalmology, Tufts University School of Medicine, Boston, put it, this survey is im- portant to help understand practice patterns in order to evaluate the effectiveness of those methods. "This survey can be used as a starting point to investigate whether the route and/or type of antibiotic ASCRS members asked about antibiotic practices M ost ophthalmologists use some form of antibiotic prophylax- is in cataract surgery cases to prevent vision- threatening infections. With a wide range of practices that have evolved over the last 20 years, just how are ophthalmologists using antibiotics prophylactically? The ASCRS Research Council sought answers to these questions in a July 2016 survey. The results of this survey, as described in "Report for Antibiotic Eyedrop Regimen for Cataract Surgical Patients Survey," will be used to help inform a pro- spective, randomized, controlled trial to establish level 1 evidence for the use of antibiotic prophylaxis in cataract surgery. The report is avail- able at ascrs.org/node/28067. "I think the creation of the Research Council is part of ASCRS' Experts discuss 2016 ASCRS antibiotics survey continued on page 75 is related to the development of en- dophthalmitis. Once we understand what is being done currently, we can track any changes in incidence rates if practice patterns change," Dr. Henderson said. The survey, completed by 556 domestic ASCRS members, found that 75.1% prescribed ophthalmic drops preoperatively and postopera- tively; the remaining 24.9% only ad- ministered drops immediately before surgery and postoperatively. The most popular preop topical antibiotic of choice was moxifloxa- cin (39.9%), followed by the "other" category (27.6%), in which respon- dents noted drugs like besifloxacin and ofloxacin (18.9%). Most of the respondents said they begin antibi- otics for routine cataract surgery 3 days preop (36.6%). About 22.6% begin antibiotics 1 day preop, and 22.0% start them on the day of surgery. The survey also asked about dosage of drops and length of time patients are instructed to contin- ue drops postop. The majority of respondents said they have patients start a postop regimen the same day as surgery, if not immediately after- ward. The majority prescribe drops for 1 week, and 54.5% recommend dosing four times a day. Of antibiotics used during routine cataract surgery, 31.3% of re- spondents used moxifloxacin, 22.1% vancomycin, 6.0% cefuroxime, and 40.6% "other," with most in the latter group stating they didn't use antibiotics during routine cataract surgery. Of those who did use anti- biotics during surgery, 35.9% said they performed an anterior chamber injection, 9.7% administered via the irrigating bottle, and 7.3% injected into the posterior chamber. Neal H. Shorstein, MD, De- partments of Ophthalmology and Quality, Kaiser Permanente, Walnut Creek, California, said the study shows an immediate opportunity to update surgeons on the recommend- ed prescribing patterns of topical drops. The randomized control trial of intracameral cefuroxime conduct- ed by the European Society of Cata- ract and Refractive Surgeons in 2007 showed no benefit of preoperative administration of the fourth gener- ation fluoroquinolone levofloxacin, Dr. Shorstein said, explaining that the ASCRS survey revealed 84% of respondents are prescribing preop drops. "Povidone-iodine instillation on the eye at the time of prep renders this practice unnecessary," he said. He added that the surgeons prescribing antibiotic drops for 2 weeks or more after surgery (16%) could increase antibiotic resistance of organisms on the eyelid, which could pose a problem should the second eye be operated on within a short time frame. David F. Chang, MD, Los Altos, California, shared his thoughts about the survey results, focusing on intracameral antibiotic prophy- laxis. He noted that the survey was initiated just prior to ASCRS and the American Society of Retina Special- ists issuing a clinical alert on hem- orrhagic occlusive retinal vasculitis (HORV), which was reported in 36 eyes of 23 patients who had received intraocular vancomycin. As such, One question the survey asked was, "If you use an antibiotic during routine cataract surgery, which of the following is your antibiotic of choice?" Source: ASCRS

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