Profilaxis Cirugia Catarata

PEER REVIEW

Peer-Reviewed Literature:

Prophylactic Intracameral
Antibiotics in Cataract Surgery
Editor: Ming Wang, MD, PhD, Clinical
Associate Professor of Ophthalmology
at the University of Tennessee and
Director of the Wang Vision Institute in
Nashville, Tennessee
Co-Editor: Tracy Swartz, OD, MS,
Educational Director at the Wang
Vision Institute in Nashville, TennesseeReviewer: Baseer U. Khan, MD, FRCS(C), fellow of
glaucoma and anterior segment at the University of
Toronto
Panel Members: Y. Ralph Chu, MD; Nina Goyal, MD;
Wei Jiang, MD; Baseer Khan, MD; Patty Lin, MD, MBA;
Gregory J. McCormick, MD; Lav Panchal, MD;
Jay S. Pepose, MD, PhD; Paul Sanghera, MD;
Renée Solomon, MD

Postoperative infectious endophthalmitis is a feared and devastating complication ofcataract surgery. Although
advances in surgical techniques and instrumentation during the last 20 years have reduced its incidence, postoperative infectious endophthalmitis following phacoemulsification continues to occur at a frequency of 0.1% or less.1,2
Because this pathologic condition is rare, its relative infrequency has made it virtually impossible to design and conduct randomized,controlled trials that will produce uniform guidelines for cataract surgeons to abide by in order to
further minimize the complication. In the absence of evidence-based guidelines, surgeons derive treatment algorithms
and practices from empirical observations and theoretical analysis to reduce the risk of the infection in patients.
Interestingly, although the role of prophylactic antibiotics in“clean cases” continues to be debated in other surgical
specialties, there is virtual unanimity among cataract surgeons in advocating antibiotic prophylaxis following uncomplicated cataract surgery.3 More accurately, the debate in the ophthalmic community has focused on the timing and
delivery of prophylaxis—pre-, intra- and/or postoperatively, via drops or intracameral instillation. The last can bedelivered either through the irrigating solution or injected as a bolus at the conclusion of the case. This article will attempt
to review some recent findings in the literature highlighting arguments for and against the use of prophylactic intracameral antibiotics while focusing specifically on vancomycin and cefuroxime. The following articles were reviewed:
1. Gimbel HV, Sun R, DeBroff BM.Prophylactic intracameral antibiotics during cataract surgery: the incidence of endophthalmitis and corneal endothelial loss. Eur J Implant Refract Surg. 1994;6:280-285.
2. Montan PG, Wejde G, Koranyi G, Rylander M. Prophylactic intracameral cefuroxime. Efficacy in preventing endophthalmitis after cataract surgery. J Cataract Refract Surg. 2002;28:977-981.
3. Liesegang TJ. Use of antimicrobials toprevent postoperative infection in patients with cataracts. Curr Opin Ophthalmol.
2001;12:68-74.
4. Han DP, Wisniewski SR, Wilson LA, et al. Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis
Vitrectomy Study. Am J Ophthalmol. 1996;122:1-17.
5. Wejde G, Montan P, Lundstrom M, et al. Endophthalmitis following cataract surgery in Sweden: national prospective survey1999-2001. Acta Ophthalmol Scand. 2005;83:7-10.
6. Gordon YJ. Vancomycin prophylaxis and emerging resistance: are ophthalmologists the villains? The heroes? Am J
Ophthalmol. 2001;131:371-376.

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7. Libre PE, Della-Latta P, Chin NX. Intracameral antibiotic agents for endophthalmitis prophylaxis: apharmacokinetic model.
J Cataract Refract Surg. 2003;29:1791-1794.
8. Axer-Siegel R, Stiebel-Kalish H, Rosenblatt I, et al. Cystoid macular edema after cataract surgery with intraocular vancomycin. Ophthalmology. 1999;106:1660-1664.
9. Montan PG, Wejde G, Setterquist H, et al. Prophylactic intracameral cefuroxime. Evaluation of safety and kinetics in
cataract surgery. J Cataract Refract Surg....