Established Practice Patterns to Prevent Postoperative Endophthalmitis after Cataract Surgery in New

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Established Practice Patterns to Prevent
Postoperative Endophthalmitis after Cataract
Surgery in New EnglandTheodoros Filippopoulos
M.D. Kent L. Anderson M.D. PhD. Paul B.
Greenberg M.D. Sunil K. Rao M.D. Nickolas P.
Katsoulakis M.D. and Elliot M. Perlman M.D.
Division of Ophthalmology Rhode Island Hospital
/ Brown Medical School Providence RI
ASCRS 2007 San Diego California USA
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Purpose To determine the established practice
patterns employed to prevent postoperative
endophthalmitis (POE) after routine cataract
surgery in New England. Methods An anonymous
questionnaire was distributed to all active New
England Ophthalmological Society members in 2006
(n700). Members who did not routinely perform
cataract surgery were excluded from subsequent
analysis. Preferences on operative technique
field sterilization pre- intra- and post-
operative antibiotics along with demographic
information were analyzed.
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Results 231 (32.9) members responded 203
(29) performed routinely cataract extractions.
Refer to figures 1 through 3 for information
regarding operative volume fellowship training
and type of practice. 185 (91) employed topical
antibiotics preoperatively. 159 of them (86)
preferred a 4th. generation fluoroquinolone. 122
(60) utilized a clear corneal incision (figure
4) and 83 (41) placed the incision temporally.
Only 160 (79) routinely irrigated the
conjunctival fornices with 5 Povidone Iodide.
The preoperative conjunctival irrigation with
dilute 5 Povidone Iodide was significantly less
popular than the use of preoperative antibiotics
(z test for 2 independent proportions plt0.05).
Intracameral antibiotics and antibiotics in the
infusion line were used by 37 (18) and 22 (11)
surgeons respectively (figure 5). Intracameral
antibiotics were associated with high operative
volume (more than 200 cases per year) (plt0.01
logistic regression) and were used in addition
and not as a substitute to pre- or post-operative
antibiotics (plt0.01 logistic regression).
Postoperatively 95 (47) surgeons performed a
subconjunctival antibiotic injection
(cephalosporins were the most prevalent choice)
and 202 (99.5) used topical antibiotics with
4th. generation fluoroquinolones being the most
popular choice (78) (figure 6).
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Demographics
Figure 1
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Demographics
Figure 2
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Demographics
Figure 3
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Operative Technique
Figure 4
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Popularity of different modalities employed to
prevent postoperative endophthalmitis expressed
as of surgeons using them. Each surgeon may
employ more than one modality.
Figure 5
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Postoperative antibiotic selection among cataract
surgeons in New England. 4FQ 4th generation
fluoroquinolone (Gatifloxacin or Moxifloxacin)
3FQ 3rd generation fluoroquinolone (Ofloxacin).
3 of study participants did not provide us with
their postoperative antibiotic of choice
Figure 6
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Conclusions 1. Most cataract surgeons in New
England routinely use pre and postoperative
topical antibiotics especially 4th generation
fluoroquinolones. 2. Conjunctival irrigation
with 5 Povidone Iodide is performed less
frequently than preoperative antibiotics despite
its clinically proven efficacy in lowering the
incidence of POE. 3. Intracameral antibiotics
are not extensively used despite recent evidence
of a direct favorable effect on the incidence of
POE.
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