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

1
Established Practice Patterns to Prevent
Postoperative Endophthalmitis after Cataract
Surgery in New England Theodoros 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
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. 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).
5.
6.
Figures 5 Popularity of different modalities
employed to prevent postoperative endophthalmitis
expressed as of surgeons using them. Each
surgeon may employ more than one modality. Figure
6 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
1.
2.
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.
3.
4.
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