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127 EW FEATURE April 2017 • Controversies in cataract surgery of bilateral infections after surgery going all the way back to 1980 or so," he said. "In every one of the first three cases it was because the patient was operated on in a cataract camp, somewhere that was septic, or in a room where there was Pseudo- monas and other infected cases," he said. "Also, there were no precau- tions taken against any infections for the first few days." In a fourth case, the staff failed to put indicators in the autoclave with the instru- ments or to turn it on, he stressed. "The instruments weren't sterile," Dr. Arshinoff said. "It's not the operation that was dangerous, but rather the fact that their protocol for sterilization was unacceptable." A possible fifth case involved a very old patient who was close to death when the surgery was performed. While the person died after getting an eye infection, the question was whether they were perhaps septic beforehand, Dr. Arshinoff noted. Still, he views intracameral anti- biotics as an important component because they control infections bet- ter. Intracameral antibiotics decrease the infection rate by 8 or 9 times, he said. While everyone touts the original European Society of Cata- ract and Refractive Surgeons study, 1 there are also many large database studies that show the intracameral (IC) approach helps to better quell infection, he notes. "There are about lens but who are undergoing the same cataract-like procedure but for the purposes of modifying their pre- scription," he said. "In that context, how is it any different?" It really has to do with general health and expectations, Dr. Solo- mon said. "When you're allowed to broach it that way, it really doesn't change much as to who really should or shouldn't be a candidate, other than making sure that the general health is good, as long as the eye is stable and we're not looking at high-risk characteristics," he said, adding, that in the context of retinal detachment, macular edema, or concerns about infection, he is likely to shy away from treating both eyes at the same time. Eyeing infection Use of intracameral antibiotics is also something that has aided physi- cians and patients alike in reducing the complication rate, Dr. Solomon continued. While not necessary, he finds that intracameral antibiot- ics give him peace-of-mind when performing bilateral procedures. "We certainly feel better knowing that we have antibiotics within the walls of the eye at the conclusion of the surgical procedure," he said, adding that this gives a measure of confidence since practitioners do see infection rates go down with intra- cameral antibiotics at their disposal. Dr. Arshinoff points out bilateral endophthalmitis, which everyone worries about, has been far from rampant, and has been decreasing in frequency over the past decade. "There have been 4, maybe 5, cases EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put "EW Pulse" in the subject line. Poll size: 208 continued on page 128 Dr. Arshinoff beginning ISBCS, left eye first. The left eye is always done first, because it allows the tray for the right eye to be brought into the room, and placed with no risk to sterility, on the opposite side of the room. Source: Steve A. Arshinoff, MD

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