Antibiotic prophylaxis: different practice patterns within and outside the United States

Area of Science:

• Ophthalmology
• Infectious Disease

Background:

• Endophthalmitis is a rare but significant cause of vision loss following ocular procedures.
• Prophylaxis strategies aim to reduce endophthalmitis rates after cataract surgery and intravitreal injections.
• Significant global variations exist in prophylaxis practices, particularly between the US and Europe.

Purpose of the Study:

• To review and compare endophthalmitis prophylaxis strategies used worldwide.
• To highlight the differences in common practices for cataract surgery and intravitreal injections.
• To discuss the evidence and controversies surrounding intracameral and topical antibiotic use.

Main Methods:

• Review of current endophthalmitis prophylaxis strategies.
• Comparison of practices in the US versus other global regions, especially Europe.
• Discussion of findings from relevant clinical trials, including the ESCRS intracameral cefuroxime trial.

Main Results:

• Intracameral antibiotics are common in Europe for cataract surgery but less so in the US.
• A European trial suggested a fivefold reduction in endophthalmitis with intracameral cefuroxime, though results are debated.
• Topical antibiotics are widely used globally but less so in the US; no RCTs exist for intravitreal injection prophylaxis.

Conclusions:

• There is no global consensus on optimal endophthalmitis prophylaxis.
• Current evidence is insufficient to definitively establish the best prophylactic techniques.
• Further large-scale clinical trials may be unlikely to resolve the debate on optimal prophylaxis.