Abstract
Abstract: :
Purpose: To evaluate the incidence of endophthalmitis and vitrectomy post–cataract surgery and the use of ocular antibiotics. Methods:Post–cataract surgery patients were identified from an employer–based database containing approximately 1.8 million lives. Patients who received at least one antibiotic prescription during the seven days before or the fourteen days following cataract surgery between 1/1/99 to 9/30/01, were eligible for study entry. Patients were required to be continuously eligible for benefits for one month prior to their initial prescription for a drug of interest and must remain eligible for a minimum of three months after their initial prescription. The date of the first prescription claim for an antibiotic of interest was defined as the index date, and the index claim for the antibiotic agent qualified the patient for study entry. The index claim for an antibiotic during the seven days prior to surgery defined the patient’s study group. Endophthalmitis diagnosis or claims for the treatment of endophthalmitis were examined. Rate of vitrectomy post–cataract surgery was also observed. Results:Cataract surgery was performed on 24,444 patients. A total of 89.8% of the patients were 65 years old or older and 58.6% were female. Overall, there were 64 patients (0.26%) identified with an endophthalmitis diagnosis. Ofloxacin (n=8,186) and ciprofloxacin (n=9,356) were the most frequently prescribed ocular antibiotics. The occurrence of endophthalmitis was 0.22% in patients treated with ofloxacin as compared to 0.31% with ciprofloxacin. The rate of vitrectomy post–cataract surgery was lower with ofloxacin (1.26%) versus ciprofloxacin (1.68%) (p<0.05). Although only 44 patients received levofloxacin as their initial antibiotic, levofloxacin had the highest percentage of post–cataract surgery patients with vitrectomy of all fluoroquinolones (4.55%) (p<0.05). A total of 4.52% of ofloxacin patients versus 8.43% of ciprofloxacin received an additional or different antibiotic post–cataract surgery (p<0.05). Conclusions:This retrospective, employer–based database study suggests differential rates of endophthalmitis, vitrectomy, and need for additional or change of antibiotic treatment depending on ocular antibiotics used pre–cataract surgery. Compared to ciprofloxacin, treatment with ofloxacin was associated with a lower rate of vitrectomy and add–on of additional antibiotic drug therapy post–cataract surgery.
Keywords: endophthalmitis • cataract • clinical (human) or epidemiologic studies: outcomes/complications