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T. Ness, W. V. Kern, U. Frank, T. Reinhard; Endophthalmitis Prophylaxis: A Single Center’s Experience and Critical Review of ESCRS Guidelines. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5387.
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To report the rate of endophthalmitis after cataract surgery in patients given preoperatively topical povidone-iodine and gentamicin-containing irrigation fluid as prophylaxis without intracameral cefuroxime or postoperative topical levofloxacin.
In a retrospective clinical study, we included patients undergoing cataract surgery within a 12-year period at a large single medical center. Cases of postoperative endophthalmitis were identified and diagnosed both clinically and microbiologically.
A total of 26,566 cataract procedures were reviewed, and 16 cases with postoperative endophthalmitis identified (rate, 0.6 per 1,000 operations, or 0.06%, 95% confidence interval, 0.03-0.09%). A causative micro-organism was detected in 81.3% (13/16) of the cases. Most organisms were gram-positive bacteria (10/13) with susceptibility to cefuroxime (9/10) and/or fluoroquinolones (4/8), and/or resistance to aminoglycosides (10/10). The three gram-negative pathogens were susceptible to cefuroxime, aminoglycosides, and fluoroquinolones.
Using our regimen of topical povidone-iodine and gentamicin-irrigation, a low rate of postoperative endophthalmitis was observed which was not much different from the infection rates recently reported in the ESCRS study (i.e. 0.5 and 0.7 per 1,000 for patients given intracameral cefuroxime with and without levofloxacin eyedrops, respectively). We speculate that neither intracameral cefuroxime nor postoperative levofloxacin eyedrops are needed to minimize postoperative infectious complications following cataract surgery, and we suggest that the ESCRS guidelines should be substantially revised to allow alternative effective regimens for the prevention of postoperative infections following cataract surgery.
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