Evaluating the necessity of topical and subconjunctival antibiotic prophylaxis in ocular surgery

The role of topical and subconjunctival antibiotics in reducing infection risk in major ocular surgeries remains unclear despite their widespread use. This review discusses the efficacy of both administration routes across various forms of surgery, underscoring evidence-based recommendations for quality practice patterns and limitations in current research.

Although intracameral antibiotics consistently result in low infection rates in phacoemulsification procedures, there may be some role for topical and subconjunctival antibiotic use, also influenced by regional preferences. Topical antibiotics may prove to be more beneficial in cases of pars plana vitrectomy and keratoprosthesis, but subconjunctival may be more beneficial in trabeculotomies.

Despite substantial data on infection incidence in ocular surgeries, gaps remain in the evaluation of specific antibiotic regimens, particularly for lesser studied procedures, such as minimally invasive glaucoma surgeries (MIGS) and ocular surface surgeries. Further research is needed to address these disparities and explore novel antimicrobial approaches.