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Alison B. Callahan, James Hoffman, John D. Pemberton, John Nguyen, Jennifer Sivak, Tory Weatherford, Edward J. Wladis, Aaron Fay; Prophylactic Post-Operative Antibiotics in Enucleation and Evisceration: A 10-year Multicenter Retrospective Chart Review. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1033.
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Enucleation and evisceration are performed for a variety of indications ranging from endophthalmitis to ‘blind painful eye.’ While much of the surgery is standardized, the benefit of prophylactic post-operative antibiotics is controversial given significant side effects from antibiotics. The use of prophylactic antibiotics in oculoplastic surgeries lacks clinical data and consequently varies widely. The purpose of this study is to understand when antibiotics are utilized and whether they reduce infectious outcomes.
Following a 1-year pilot study, we initiated a 10-year, multicenter retrospective chart review of enucleations and eviscerations at Massachusetts Eye and Ear Infirmary (MEEI), Albany Medical Center (AMC), University of Arkansas (UA) and West Virginia University Eye Institute (WVUEI). Data examining demographics, surgical indication, post-operative oral or intravenous antibiotics and infectious outcomes are analyzed from the last 10 years.
To date, we have reviewed 381 cases between 4/1/2001 and 3/31/2011: 107 from MEEI, 87 from AMC, 167 from WVUEI and 20 from UA. Prophylactic antibiotics were used in 43% of cases. There was a statistically significant difference in their use for cases with infectious indications (25 of 40 cases, or 63%) versus non-infectious indications (137 of 341 cases, or 40%) (two-tailed z-test, p=0.005). There were only three cases with presumed post-operative infections, two of which were despite prophylactic post-operative antibiotics and two of which had infectious indications for surgery. While these are compiled data, variability among centers was also apparent, which we look forward to detailing further.
Thus far, we find that post-operative infection rates are low, irrespective of prophylactic post-operative antibiotics, and that prophylactic antibiotics appear to be preferentially used by surgeons in the setting of infectious indications. Two of three presumed post-operative infections occurred despite antibiotic prophylaxis, and two of three post-operative infections occurred in patients with pre-existing infectious indications for surgery. Thus, based on the substantial data compiled to date, it appears that prophylactic post-operative antibiotics may not provide a benefit, and therefore may not be universally indicated; rather, they may be better implemented preferentially according to the clinical scenario.
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