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Mona Adeli, Thomas Mauger; Incidence of Cystoid Macular Edema after Intracameral Vancomycin in Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1831. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Various studies have demonstrated the efficacy of intracameral antibiotics in decreasing the incidence of endophthalmitis after cataract surgery. While many of the initial studies utilized intracameral cephalosporin agents, intracameral vancomycin has been used as an alternative in penicillin-allergic patients. The purpose of this study was to compare the incidence of pseudophakic cystoid macular edema (CME) in subjects who received intracameral cephalosporin versus intracameral vancomycin during cataract surgery.
A retrospective chart review was conducted on all subjects at our academic institution with the diagnosis of CME by ICD code between the time period of January 1, 2010 and June 30, 2015. Inclusion criterion was the documentation of CME within a 90-day post-operative period after cataract surgery. Exclusion criteria were prior history of macular edema, history of epiretinal membrane, concomitant vitreoretinal surgery at the time of cataract extraction, intraoperative posterior capsule tear, and history of diabetes mellitus. A Pearson’s chi-square test was used for statistical analysis.
The final analysis included a total of 24 subjects (29 eyes) with CME. The incidence of pseudophakic CME in our population of 7,822 cataract surgeries after applying the above-stated exclusion criteria was 0.37%. The incidence of pseudophakic CME was 0.33% in subjects who received intracameral cephalosporin, and 0.78% in subjects who received intracameral vancomycin. There was no significant difference between the incidence of CME between these groups (p = 0.054).
This study demonstrated a trend toward a higher incidence of CME in subjects who received intracameral vancomycin as opposed to intracameral cephalosporin during cataract surgery. This finding was not, however, statistically significant. However, the morbidity associated with the development of CME is much lower than that associated with the development of endophthalmitis. Additional research must be conducted to determine the safest endophthalmitis prophylaxis in the population of penicillin- and cephalosporin-allergic patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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