Endophthalmitis is a serious complication of cataract surgery that every ophthalmic surgeon – and patient – strives to avoid. The visual loss and debilitation that occur in a large proportion of postoperative endophthalmitis cases can be severe and irreversible.
Those most in need of the operation are often those at greatest risk, such as the elderly. Without knowing exactly how, when or why to intervene with effective prophylactic measures, virtually every surgeon today follows a standard of care that involves antisepsis and antibiotics.
Although cataract surgery ranks among the most frequently performed surgical procedures worldwide, data to define the most effective prophylactic measures have been nearly impossible to generate, given the large patient numbers needed to conduct clinical trials. Prevention and elimination of postoperative endophthalmitis, however, is a constant goal of every ophthalmic surgeon.
The clinical practice of administering a direct intracameral injection of cefuroxime at the close of cataract surgery to reduce endophthalmitis rates was first implemented by a group of Swedish surgeons. The clinical benefit of this intervention seemed apparent.
In order to test the hypothesis in a scientific manner, the European Society of Cataract and Refractive Surgeons mounted a large randomized clinical trial to evaluate the intracameral injection in a prospective, randomized fashion across nine European countries.
Results published in 2007 unequivocally demonstrated a clinical benefit, with a five-fold reduction in postoperative endophthalmitis rates in patients who received a 1mg intracameral injection of cefuroxime at the close of cataract surgery.
In the wake of these results, a growing number of centres have adopted this method of prophylaxis, reporting even more striking effects, on occasion, than the ESCRS study itself.
The landmark article from the ESCRS Endophthalmitis Study Group. This article has now been cited over 600 times.
Per Montan et al. To evaluate the safety and kinetics of prophylactic intracameral cefuroxime in cataract surgery.
Per Montan et al. Presented at the XVIth Congress of the European Society of Cataract & Refractive Surgeons, Nice, France, September 1998, the XIIth meeting of the European Society of Ophthalmology, Stockholm, Sweden, June 1999, and the XIIIth meeting of the European Society of Ophthalmology, Istanbul, Turkey, June 2001.
An update on the original landmark 2007 study
Data on practice patterns for prophylaxis against infectious postoperative endophthalmitis (IPOE) during cataract surgery in 9 European countries were searched in national registers and reviews of published surveys. Summary reports assessed each nation’s IPOE rates, nonantibiotic prophylactic routines, topical and intracameral antibiotic use, and coherence to the European Society of Cataract & Refractive Surgeons (ESCRS) 2007 guidelines.
This article showed that swollen lids, pain, and an opaque vitreous were statistically associated with proven endophthalmitis cases in the ESCRS study.
The European Society of Cataract & Refractive Surgeons Endophthalmitis Study published preliminary results in 2006 showing a near 5-fold decrease in the rates of postoperative endophthalmitis with the use of intracameral cefuroxime. The study findings have generated considerable controversy, and 1 year later its recommendations had been heeded by only 6% of American Society of […]
To aid the cataract surgeon’s understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. […]
One of the original arguments for adopting a multicenter study to investigate prophylaxis of postoperative endophthalmitis after cataract surgery:
Contention has slowly given way to consensus in the cross-Atlantic debate on the merits of intracameral antibiotic prophylaxis following cataract surgery, suggests a debate held at the 2015 American Society of Cataract and Refractive Surgery Symposium in San Diego.
In the United States, an observational, longitudinal cohort study was carried out to examine the effect of topical and injected antibiotics on risk of endophthalmitis.
315 246 eligible cataract procedures in 204 515 members of Kaiser Permanente, California, 2005–2012.