Systematic Review of Clinical Practice Guidelines for Post-Cataract Surgery Endophthalmitis Prophylaxis from...

Area of Science:

• Ophthalmology
• Infectious Disease Prevention
• Evidence-Based Medicine

Background:

• Postoperative endophthalmitis is a serious complication of cataract surgery, potentially leading to vision loss.
• Existing clinical practice guidelines (CPGs) offer diverse recommendations for prophylaxis.
• Variability in CPGs necessitates a synthesis of current recommendations.

Purpose of the Study:

• To systematically review and evaluate global clinical practice guidelines for endophthalmitis prophylaxis after cataract surgery.
• To identify common prophylactic strategies and areas of divergence among guidelines.
• To assess the quality of existing guidelines.

Main Methods:

• Comprehensive literature search including citation and gray literature.
• Contact with international ophthalmologists for additional guidelines.
• Inclusion of CPGs on post-cataract surgery endophthalmitis prophylaxis (2008-2023).
• Quality assessment using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.

Main Results:

• Twenty-one guidelines were identified and analyzed.
• Intracameral antibiotics, conjunctival povidone-iodine instillation, and periorbital skin preparation were frequently recommended.
• Significant variations were noted in concentrations, dosages, contact times, and the inclusion of ancillary measures like topical antibiotics or eye protection.

Conclusions:

• Core prophylactic strategies for endophthalmitis after cataract surgery show broad agreement.
• Discrepancies in guidelines likely stem from local regulations, practice variations, and evidence interpretation.
• Tailoring prophylactic measures to individual patient characteristics and circumstances is essential.