Country-Specific Approaches to Preventing Infections in Cataract Surgery

Antimicrobial resistance (AMR) is a major global health threat. In patients undergoing cataract surgery, AMR complicates infection control, particularly efforts to reduce the risk of endophthalmitis-a rare but severe postoperative complication. This article reviews country-specific strategies for endophthalmitis prevention, focusing on antimicrobial use.

Ophthalmology experts from 10 countries contributed national perspectives on infection prevention. Official guidelines served as the primary basis for analysis; when unavailable, expert opinion and routine clinical practice were considered.

Routine preoperative antibiotic use is uncommon in 6 out of 10 countries. Instead, artificial tears and bacteriostatic or bactericidal treatments are frequently employed. One country allows optional antibiotic use, while 3 include it in routine preoperative care. For intraoperative management, antisepsis with 5-10% povidone-iodine is standard practice in 9 countries. Intracameral cefuroxime (typically 1 mg/0.1 mL) is widely used in 7 countries and considered essential in most countries. Postoperatively, broad-spectrum topical antibiotics, primarily fluoroquinolones, are typically prescribed, often as fixed-dose combinations with corticosteroids (8 countries), although duration and regimens vary.

Despite national differences, povidone-iodine, intracameral cefuroxime, and topical fluoroquinolones are widely used. Preoperative antibiotic use varies, while postoperative regimens are more consistent. These practices reflect local AMR patterns, regulations, and available healthcare resources. Although broad-spectrum agents are generally preferred, they raise concerns about resistance. Tailoring prophylactic strategies to local microbiological profiles and limiting the duration of antibiotic therapy are key to balancing efficacy and stewardship. An individualized, evidence-based approach is essential to reduce endophthalmitis risk and address AMR challenges.