Prevention of Postoperative Endophthalmitis after Cataract Surgery with an Intraoperative Gentamycin Antibiotic...

PURPOSE: This study describes a protocol for applying gentamicin through the irrigation solution of the phacoemulsification machine to prevent postoperative endophthalmitis (PE) after cataract surgery.

METHODS: This is a retrospective descriptive single centre analysis. The study protocol adhered to the Declaration of Helsinki and was approved by the institutional review board (Swiss Ethics No. 2024-02274). Cataract surgeries were conducted with an antibiotic prophylaxis of gentamicin at 0.08 mg/ml, administered continuously through the balanced salt solution (BSS), between 2014 and 2024 in the Vista eye clinic Binningen, and were filtered out of the electronic patient records. Cases with PE were specifically filtered out and differentiated from toxic anterior segmented syndrome (TASS). Subsequently the incidence of PE was calculated.

RESULTS: 57 040 cataract operations in the 10-year period adhered to the filtration criteria. Three cases were classified as PE, which is equivalent to an incidence of 0.005% (0.0004 - 0.0150). Seven cases were classified as TASS, which equals an incidence of 0.01% (0.0051 - 0.0251).

CONCLUSION: With a retrospective single centre design, the low incidence of PE using the gentamicin irrigation protocol at hand cannot be generalised. So far there is no high-quality evidence, supporting the role of gentamicin in PE prevention and the standard remains cefuroxime bolus-based PE prevention. However, gentamicin's spectrum of activity and its synergistic effect with cell wall active antibiotics might warrant further investigation to this end.