Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis: Analysis of 600 000 Surgeries.

Endophthalmitis after Cataract Surgery in the United States: A Report from the Intelligent Research in Sight Registry, 2013-2017.

Endophthalmitis (inflammation of the inside of the eyeball due to infection or trauma) is a rare but potentially blinding complication of cataract surgery. It typically is caused by bacteria that enter the eye during surgery or in the first few days after surgery. Multiple preventive measures are used to try to prevent infection after surgery. Several studies have investigated different modes of prevention such as the types of antibiotics used, how the antibiotics are applied or taken, and when the antibiotics are given in the surgical process.
The authors searched the literature for randomized controlled trials of cataract surgery that evaluated giving antibiotics shortly prior to, during, or immediately after surgery to prevent acute endophthalmitis. Four trials with a total of 100,876 adults and 131 endophthalmitis cases met the inclusion criteria. Of these four trials, two reported reduced rates of endophthalmitis when comparing antibiotics injected into the eye versus antibiotics given in eye drops. In one study, penicillin injected into the eye resulted in a 67% reduction in endophthalmitis after surgery. In the more recent ESCRS study, cefuroxime injected into the eye reduced the risk of endophthalmitis by 80% to 90%, depending on whether antibiotic drops were also utilized. This study provides the best available current evidence for antibiotic prevention of endophthalmitis. Cefuroxime is used widely in Europe but on a limited basis in the United States, where some physicians have expressed concerns regarding risk of contamination or dilution errors during the compounding process (preparing drugs for ocular use) that could cause ocular toxicity (harms). 
Given that clinical trials with rare outcomes need to enroll a large number of participants and are costly to conduct, it is unlikely that additional clinical trials will be conducted to assess how well perioperative antibiotic prophylaxis works to prevent acute endophthalmitis after cataract surgery. Practitioners should consider the evidence shown by the ESCRS study, that antibiotics injected into the eye are likely to reduce the risk of endophthalmitis after cataract surgery when they can be sterilely obtained and delivered.

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Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.

Background Current practice methods are unclear as to the most safe and effective prophylactic pharmacotherapy and method of delivery to reduce postoperative endophthalmitis occurrence. Methods A systematic review and meta-analysis using Meta-analysis of Observational Studies in Epidemiology guidelines was performed to compare the efficacy of intracameral cefuroxime, moxifloxacin and vancomycin in preventing postphacoemulsification cataract surgery endophthalmitis. A safety analysis of intracameral antibiotics was concurrently performed. Data sources BIOSIS Previews, CINAHL, ClinicalTrials.gov, Cochrane Library, Dissertations & Theses, EMBASE, PubMed, ScienceDirect and Scopus were searched from inception to January 2017. Data were pooled using a random effects model. All articles were individually reviewed and data were extracted by two independent reviewers. Funnel plot, risk of bias and quality of evidence analyses were performed. Results Seventeen studies with over 900 000 eyes were included, which favoured the use of intracameral antibiotics at the end of cataract surgery (OR 0.20; 95% CI 0.13 to 0.32; P 0.3). Most studies had low to moderate risk of bias. The safety analysis showed minimal toxicity for moxifloxacin. Dosing errors led to the majority of toxicities with cefuroxime. Although rare, vancomycin was associated with toxic retinal events. Conclusion Intracameral cefuroxime and moxifloxacin reduced endophthalmitis rates compared with controls with minimal or no toxicity events at standard doses. Additionally, intracameral antibiotics alone may be as effective as intracameral plus topical antibiotics.

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Comparative analysis of the safety and efficacy of intracameral cefuroxime, moxifloxacin and vancomycin at the end of cataract surgery: A meta-analysis

Purpose To analyze the posterior capsule rupture (PCR) rates among staff and trainee cataract surgeons, and the postoperative endophthalmitis (POE) rates in uncomplicated and complicated eyes both with and without intracameral moxifloxacin prophylaxis (ICMP). Setting Ten regional Aravind Eye Hospitals in India. Design Retrospective multicenter clinical registry within a single hospital network. Methods POE rates with and without ICMP were statistically compared for all eyes and separately for trainees versus staff, for phacoemulsification versus manual small-incision cataract surgery (M-SICS), and for a subgroup of eyes complicated by PCR or requiring secondary surgery. Results All cataract surgeries (2 062 643) performed during the 8-year period from 2011 to 2018 at the 10 regional Aravind Eye hospitals were included in the analysis. With ICMP, the overall POE rate declined from 692 (0.07%) of 993 009 eyes to 185 (0.02%) of 1 069 634 eyes (P  Conclusions ICMP reduced the POE rate overall, with phacoemulsification, with M-SICS, and in eyes with PCR.

Endophthalmitis reduction with intracameral moxifloxacin in eyes with and without surgical complications: Results from 2 million consecutive cataract surgeries.

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

Background Injuries resulting from sharp and cutting objects and exposure to patients’ blood and other body fluids are considered as one of the most important occupational hazards facing health care personnel due to exposure to blood-borne viruses such as Hepatitis B and C and HIV. The aim of this study is to investigate occupational hazards that involve safe handling of sharp and penetrating objects by nursing staff working in paediatrics hospitals of Tehran University of Medical Sciences (2006–2009). Methods In this descriptive study, nursing personnel employed at the paediatrics hospitals of Tehran University of Medical Sciences were selected. Data were collected through a self-administered questionnaire containing two parts; part one was related to demographic information and part two focussed on details of injurious incidents. The collected data were analyzed using SPSS software, version 16. Results The study population reported 134 needle stick injuries(134HCWs exposure group, 380 HCW1s not exposure group). The incidence rate of NSI was 26.07% (8.17% per year). In most cases, needles (40.3%) and vein catheters (28.36%) were accounted for injuries. IV access (31.33%) and recapping of needles (20.9%) were most common action resulted to exposure. There was no statistically significant difference in demographic variables except in work experience between two groups. Conclusion Based on the findings of this study, the incidence rate of NSI among HCWs working in paediatrics wards was less than those of other studies in different countries. This might be related to inadequate reporting, and also our results emphasize the importance of training and education of nursing personnel for reporting needle stick injuries.

https://ijcbnm.sums.ac.ir/article_40649_27655c2d8e1ee97a4783edb604407d95.pdf

An Investigation into Occupational Hazards Faced by Nurses in Paediatrics Hospitals of Tehran University of Medical Sciences, 2006-2009

Introduction: Today, Needle Stick Injuries (NSI) are very important occupational hazards
experienced by healthcare workers lead to exposure to blood-borne viruses especially
hepatitis B, hepatitis C and HIV. The aim of this study was to determine needle sticks
injuries among health care workers in emergency medical centers in Tehran University of
Medical Sciences hospitals (2007-2010).
Materials and Methods: In this descriptive study 991 health care workers worked in
emergency wards in Tehran University of Medical Sciences hospitals were followed for
needle stick events from 2007 to 2010. Sampling method was census. Data were collected by
a researcher-made questionnaire consisted of 32 questions included demographic variables
and NSI included the event that leads to needle stick injuries. Content and face validity and
also test-retest reliability (r = 0/71) were measured and data was analyzed by SPSS 16.
Findings: The study population reported 167 needle stick injuries during the study period
(167 health care workers exposure group, 554 health care workers not exposure group).
Incidence rate of NSI was 16/85%. Majority of subjects in exposure group were female
(50/89%), married (52/69%) and nurse (53/2 %) and also the mean age was 35/3 6/4. In
most cases, needles (55/08%) and vein catheter (22/75%) were responsible for injuries. IV
access (24/7%) and recapping of needles (23/3%) were most common action resulted to
exposure. There weren't statistically significant different in demographic variables except
working experience between exposure groups and not exposure group.
Conclusion: According to the results of this study, incidence rate of NSI among HCWs
worked in emergency wards in TUMS less than other studies in different countries. This
might be an indication of inadequate reporting. It is suggested that, NSI in hospitals should be
managed through obtaining an appropriate reporting system and organizing blood and body
fluid exposure surveillance system.

Shadi Rezaei

Papers

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

An Investigation into Occupational Hazards Faced by Nurses in Paediatrics Hospitals of Tehran University of Medical Sciences, 2006-2009

Needle sticks injuries among health care workers in emergency medical centers in Tehran University of Medical Sciences Hospitals (2007-2010)