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Anthony F. Kokx, Robert E. Weir, Zvi Kresch, John Nguyen, Jennifer Sivak, Yvette Santiago, John D. Pemberton, Aaron Fay; Prophylactic Postoperative Antibiotics For Patients Undergoing Enucleation Or Evisceration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1060.
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Prophylactic antibiotics have been used for over 70 years to reduce surgical site infections. Pre-operative intravenous antibiotics have been shown to be effective in preventing postoperative infection in general and orthopedic surgeries. They have not been found to be statistically significant for plastic and reconstructive surgery patients and are debatable in patients with alloplastic implants. No definitive conclusion has been reached regarding the use of post-operative antibiotic prophylaxis for any field of surgery. The purpose of this study is to determine the necessity and utility of prophylactic post-operative antibiotics in patients undergoing elective enucleation and evisceration with or without orbital implant.
A comparative interventional study of adults undergoing elective enucleaction or evisceration at the Massachusetts Eye & Ear Infirmary and West Virginia University Eye Institute from January 1, 2010 to December 31, 2010 was performed. Demographics, surgical indication, surgical technique, peri- and post-operative antibiotics, and treatment outcome were recorded through a retrospective chart review.
Between January 1, 2010 and December 3, 2010, twenty-eight adults underwent elective, uncontaminated evisceration or enucleation surgeries with or without porous orbital implants (25 enucleations & 3 eviscerations) for blind painful eye. One patient did not receive an orbital implant. All patients received a peri-operative intravenous dose of either cephalosporin or lincosamide antibiotics. Eighteen patients (64%) received postoperative oral antibiotics of penicillin based or lincosamide antibiotics, and 10 (36%) did not. No postoperative infection was seen in either group of patients at the last follow up visit. No statistically significant difference in postoperative infection rate was noted between the two groups (p=0.05).
Prophylactic post-operative antibiotics appear to be unnecessary in patients undergoing sterile, elective enucleation or evisceration surgery with or without alloplastic implant. While our patient sample is small, the relatively clean nature of the operation suggests that many patients would be subjected to potential side effects of antibiotics to prevent a rare infection. Thorough post operative examination to look for infection and appropriate treatment are critical to decrease post-operative morbidity.
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