ABSTRACT
PURPOSE: This large retrospective observational study describes the evolution of the rates of postoperative endophthalmitis in cataract surgery in a 16-year period, and compares them before and after two different changes in the prophylaxis protocol of a general hospital in Barcelona, Spain. METHODS: This study included all the phacoemulsification procedures performed from January 2002 to December 2017. In January 2004, intracameral cefazolin at the end of the surgery was added to the prophylaxis protocol of cataract surgery. In January 2011, topical postoperative ofloxacin was replaced by topical moxifloxacin. Cumulative incidences of postoperative endophthalmitis before and after the addition of intracameral cefazolin and the change of ofloxacin by moxifloxacin as postoperative topical treatment were compared. RESULTS: The study included 55,984 surgeries. In the period after the introduction of intracameral cefazolin (2004-2010), the cumulative incidence of endophthalmitis was 0.047% (95% CI 0.019-0.099%), significantly lower than in the previous period. From January 2011 to December 2017, after the postoperative change of topical ofloxacin by moxifloxacin, the cumulative incidence dropped to 0.0037% (95% CI 0.000468-0.01862%), with a relative risk reduction between both periods of 91.3%. CONCLUSION: An intracameral bolus of cefazolin was a very effective prophylaxis of endophthalmitis in cataract surgery. The continuous surveillance and prophylaxis protocol revision over time further reduced the incidence of this complication to extremely low levels.
Subject(s)
Cefazolin/administration & dosage , Endophthalmitis/prevention & control , Eye Infections, Bacterial/prevention & control , Forecasting , Moxifloxacin/administration & dosage , Phacoemulsification/adverse effects , Surgical Wound Infection/prevention & control , Administration, Topical , Aged , Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis/methods , Endophthalmitis/diagnosis , Endophthalmitis/etiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/etiology , Female , Follow-Up Studies , Humans , Injections, Intraocular , Male , Postoperative Care/methods , Retrospective Studies , Surgical Wound Infection/diagnosis , Surgical Wound Infection/etiologyABSTRACT
PURPOSE: To assess the use of intracameral cefazolin in preventing endophthalmitis in cataract surgery. SETTING: Ophthalmology Department, L'Hospitalet de Llobregat, Barcelona, Spain. METHODS: This study was of phacoemulsification procedures performed from January 2002 to December 2007. In January 2004, intracameral cefazolin given at the end of the surgery was added to the prophylaxis protocol of cataract surgery. The cumulative incidence of postoperative endophthalmitis before and after the addition of intracameral cefazolin was compared. RESULTS: During the study period, 18579 phacoemulsification procedures were performed. In the 2-year period before introduction of intracameral cefazolin prophylaxis, 25 cases of endophthalmitis were diagnosed in 5930 surgeries, leading to a cumulative incidence of 0.422% (95% confidence interval [CI], 0.279%-0.613%). After the introduction of cefazolin, 6 cases of endophthalmitis were diagnosed in 12649 surgeries, an incidence of 0.047% (95% CI, 0.019%-0.099%). When only microbiologically proven cases were considered, the cumulative endophthalmitis incidence was 0.388% (95% CI, 0.252%-0.572%) in the first study period and 0.032% (95% CI, 0.010%-0.076%) in the second study period (P<.0000001). The relative risk for presenting with endophthalmitis in the first study period compared with the second period was 8.89 (95% CI, 3.65-21.65). CONCLUSIONS: A 2.5 mg/0.1 mL intracameral bolus of cefazolin provided excellent prophylactic effectiveness, with a reduction in the incidence of endophthalmitis from 0.422% to 0.047%, corresponding to a relative risk reduction of 88.7% (95% CI, 72.6%-95.4%). Cefazolin fulfills international recommendations on antimicrobial prophylaxis for surgical site infections and is easier to obtain in developing countries.
Subject(s)
Anterior Chamber/drug effects , Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Cefazolin/therapeutic use , Endophthalmitis/prevention & control , Eye Infections, Bacterial/prevention & control , Phacoemulsification , Acute Disease , Aged , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Female , Humans , Incidence , Male , Postoperative Period , Risk Reduction BehaviorABSTRACT
PURPOSE: To compare the protective effect of Healon5 (sodium hyaluronate 2.3%) and Amvisc Plus (sodium hyaluronate 1.6%) against corneal edema and their association with postoperative intraocular pressure (IOP) spikes in patients having phacoemulsification and intraocular lens (IOL) implantation. SETTING: Ophthalmology department of a general hospital. METHODS: One hundred forty patients were randomly assigned to have surgery with Healon5 (n = 70) or Amvisc Plus (n = 70). One eye of each patient was analyzed. Data collected preoperatively included best corrected visual acuity (BCVA) and IOP. Central ultrasonic pachymetry was performed in all patients. The same ophthalmologist performed all surgeries. The IOP and central corneal thickness (CCT) were measured 1 and 4 days and 1 month after surgery. The BCVA was also assessed at 1 month. RESULTS: There were no significant preoperative differences between the Healon5 and Amvisc Plus groups in sex, age, ocular pathology, BCVA, IOP, or CCT. Intraoperative variables were similar between groups, but it took significantly longer to remove the Healon5. Postoperatively, there were no differences between groups in the evolution of CCT or of IOP. Intraocular pressure spikes over 30 mm Hg were detected at 1 day in 7 patients in the Healon5 group and 2 patients in the Amvisc Plus group (10.0% versus 2.9%; P = .165). CONCLUSIONS: Both OVDs were beneficial in a wide range of cataract patients. However, the results suggest a tendency toward a higher complication rate with Healon5.
