Cataract in the Adult Eye Preferred Practice Pattern

A 2014 online survey of the American Society of Cataract and Refractive Surgery members indicated increasing use of intracameral antibiotic injection prophylaxis compared with a comparable survey from 2007 Forty-seven percent of respondents already used or planned to adopt this measure One half of all surgeons not using intracameral prophylaxis expressed concern about the risks of noncommercially prepared antibiotic preparations Overall, the large majority (75%) said they believe it is important to have a commercially available antibiotic approved for intracameral injection Assuming reasonable cost, the survey indicates that commercial availability of Aprokam (cefuroxime) would increase the overall percentage of surgeons using intracameral antibiotic injection prophylaxis to nearly 84% Although the majority used topical perioperative antibiotic prophylaxis, and gatifloxacin and moxifloxacin were still the most popular agents, there was a trend toward declining use of fourth-generation fluoroquinolones (60%, down from 81% in 2007) and greater use of topical ofloxacin and ciprofloxacin (21%, up from 9% in 2007)

Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey.

Rickettsioses in Europe

Endophthalmitis is one of the most feared complications after cataract surgery. The aim of this systematic review was to evaluate the effect of intracameral and topical antibiotics on the prevention of endophthalmitis after cataract surgery. A systematic literature review in the MEDLINE, CINAHL, Cochrane Library and EMBASE databases revealed one randomized trial and 17 observational studies concerning the prophylactic effect of intracameral antibiotic administration on the rate of endophthalmitis after cataract surgery. The effect of topical antibiotics on endophthalmitis rate was reported by one randomized trial and one observational study. The quality and design of the included studies were analysed using the Cochrane risk of bias tool. The quality of the evidence was evaluated using the GRADE approach. We found high-to-moderate quality evidence for a marked reduction in the risk of endophthalmitis with the use of intracameral antibiotic administration of cefazolin, cefuroxime and moxifloxacin, whereas no effect was found with the use of topical antibiotics or intracameral vancomycin. Endophthalmitis occurred on average in one of 2855 surgeries when intracameral antibiotics were used compared to one of 485 surgeries when intracameral antibiotics were not used. The relative risk (95% CI) of endophthalmitis was reduced to 0.12 (0.08; 0.18) when intracameral antibiotics were used. The difference was highly significant (p < 0.00001). Intracameral antibiotic therapy is the best choice for preventing endophthalmitis after cataract surgery. We did not find evidence to conclude that topical antibiotic therapy prevents endophthalmitis.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/aos.12684

Antibiotic prevention of postcataract endophthalmitis: a systematic review and meta-analysis

Endophthalmitis Occurring after Cataract Surgery: Outcomes of More Than 480 000 Cataract Surgeries, Epidemiologic Features, and Risk Factors.

PurposeTo present the results of a retrospective comparative unicentric institutional study of the incidence of postcataract surgery endophthalmitis before and after the introduction of the Europea...

Postcataract surgery endophthalmitis after introduction of the ESCRS protocol: a 5-year study.

Background: Mediterranean spotted fever is a zoonosis endemic in the Mediterranean region. The microorganism Rickettsia conorii is responsible for the disease due to its angiotropism for endothelial cells. It produces host cell necrosis, thrombosis, and organ dysfunction. Ophthalmologic manifestations are rare. Findings: The authors describe the case of a 55-year-old female with Mediterranean spotted fever who developed localized retinal vasculitis with associated macular edema. Treatment with intravitreal triamcinolone allowed a significant recovery of visual acuity. Conclusion: Ophthalmological symptoms in these patients should be emphasized because there can be severe ocular complications with a potentially irreversible loss of visual acuity.

/pdf/a-rare-case-of-retinal-artery-occlusion-in-the-context-of-1p7ec9chbs.pdf

A Rare Case of Retinal Artery Occlusion in the Context of Mediterranean Spotted Fever

Resumen Introduccion Presentamos el caso de una paciente con una hemorragia premacular tratada con neodimio (Nd):YAG laser. Caso clinico Paciente de 54 anos de edad fue a urgencias por perdida repentina de vision en el ojo derecho (OD) desde el dia anterior. La maxima vision corregida del OD era la percepcion de la luz y en el fondo de ojo se vio una hemorragia premacular de gran tamano. Se hizo el tratamiento con Nd:YAG laser en ese dia para que drenase la hemorragia hacia la cavidad vitrea. En la hemorragia intravitrea habia desaparecido al cabo de un mes y despues de 3 meses la vision era 20/25.

Luís Violante

Papers

Postcataract surgery endophthalmitis after introduction of the ESCRS protocol: a 5-year study.

A Rare Case of Retinal Artery Occlusion in the Context of Mediterranean Spotted Fever

Tratamiento con láser Nd:YAG en una hemorragia premacular: caso clínico

[Premacular hemorrhage treatment with Nd:YAG laser: a clinical case].