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Lisa Dang, Jayne S Weiss; Endophthalmitis Prophylaxis for Cataract Surgery in State versus Private Institutions - Does it Vary?. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2814.
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There is no standard regimen for endophthalmitis prophylaxis in routine cataract surgery, though studies have shown there is a strong preference for the use of preoperative topical fluoroquinolones. Louisiana (LA) has state clinics and hospitals, which primarily serve the uninsured and indigent population. Recently, we discovered a potential difference in the practice patterns of LA ophthalmologists operating in state versus private institutions. To evaluate these differences, a survey was administered to LA ophthalmologists.
In November 2013, an electronic survey was sent to ophthalmologists of the Louisiana State University (LSU) Alumni Association, New Orleans Academy of Ophthalmology, LA Ophthalmology Association and LSU/Ochsner Medical Center Department of Ophthalmology. The cataract surgery survey contained eight questions pertaining to the location of performed surgeries, the use of pre- or intraoperative antibiotic prophylaxis and povidone-iodine, preferred antibiotic regimen at different locations, and rate of endophthalmitis.
A total of 33 valid surveys were completed. 20 surgeons operated in private facilities only, 4 in state hospitals only, and 9 in both private and state facilities. 100% (29) of surgeons operating in private facilities and 8% (1) of surgeons operating in state facilities used preoperative topical antibiotics. 100% (33) placed a drop of povidone-iodine inside of the operative eye prior to surgery. 10% (3) of surgeons operating in private facilities also used intracameral antibiotics. 100% (9) of surgeons operating in both private and public facilities used different regimens in each facility. Within this subgroup, 0% reported using preoperative antibiotics when operating in a state facility though all used preoperative antibiotics in private practice. The majority of all surgeons reported less than 1/1000 rate of infectious endophthalmitis.
The results imply that practice patterns for antibiotic prophylaxis in cataract surgery vary, but the majority of LA ophthalmologists prefer to use preoperative topical antibiotics. This differs from the regimen used by those operating in state institutions in which no preoperative antibiotics are used. The lack of preoperative antibiotic prophylaxis for cataract surgery in LA state hospitals affords us the opportunity to determine if there is an adverse effect on the rate of endophthalmitis.
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