Post-operative endophthalmitis

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Summary of Evidence

Evidence

1. General

Review

2021 Peck et.al.

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2021
Review

Review of endophthalmitis following cataract surgery:

The IRIS registry indicates the rates of endophthalmitis are decreasing in the United States, and the outcomes appear to be improving. Intracameral moxifloxacin has become more widely accepted and intracameral vancomycin has been shown to be associated with retinal vasculitis. The role of systemic antibiotics and vitrectomy is unclear and practice patterns vary widely.{Peck TJ, Patel SN, Ho AC. Endophthalmitis after cataract surgery: an update on recent advances. Curr Opin Ophthalmol. 2021 Jan;32(1):62-68.}

Review

2018 Rahmani and Eliot

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2018
Review

Review of clinical features, risk factors, prophylaxis, and treatment of post-operative endophthalmitis following cataract extraction, glaucoma drainage implants/trabeculectomy, and pars plana vitrectomy. {Rahmani S, Eliott D. Postoperative Endophthalmitis: A Review of Risk Factors, Prophylaxis, Incidence, Microbiology, Treatment, and Outcomes. Semin Ophthalmol. 2018;33(1):95-101.}

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Review

2017 Garg et.al.

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2017
Review

Review of endophthalmitis following cataract surgery:

The published literature highlights that the incidence rate of endophthalmitis declined after 2007. Simultaneously, there is a rising trend for using intracameral injection of antibiotics at the conclusion of cataract surgery. Although various drugs have been used for this purpose, nearly all provide comparable protection. {Garg P, Roy A, Sharma S. Endophthalmitis after cataract surgery: epidemiology, risk factors, and evidence on protection. Curr Opin Ophthalmol. 2017 Jan;28(1):67-72.}

1.1. Epidemiology

Review

2011 Sheng et.al.

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2011
Review

The incidence of endophthalmitis after cataract surgery in China from 1995-2009 was 0.06% (140/233,115). Treatments included intraocular antibiotic injection in 54.1% of eyes and immediate vitrectomy in 40.2%. Of 356 intraocular samples, 214 (60.1%) were culture positive; 187 (87.3%) bacterial and 27 (12.7%) fungal. {Sheng Y, Sun W, Gu Y, Lou J, Liu W. Endophthalmitis after cataract surgery in China, 1995-2009. J Cataract Refract Surg. 2011 Sep;37(9):1715-22.}

1.2. Risk factors

Clinical trial

2007 ESCRS group

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2007
Clinical trial

Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis.
Additional risk factors associated with endophthalmitis after cataract surgery included CCIs and the use of silicone IOLs.{Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007 Jun;33(6):978-88.}

2. Perioperative antibiotics

2.1. Intracameral antibiotics

Systematic review

2017 Gower et.al. (Cochrane)

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2017
Systematic review

High-certainty evidence shows that injection with cefuroxime with or without topical levofloxacin lowers the chance of endophthalmitis after surgery

Moderate-certainty evidence to suggest that using antibiotic eye drops in addition to antibiotic injection probably lowers the chance of endophthalmitis compared with using injections or eye drops alone.{Gower EW, Lindsley K, Tulenko SE, Nanji AA, Leyngold I, McDonnell PJ. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database Syst Rev. 2017 Feb 13;2(2):CD006364.}

Five studies met the inclusion criteria for this review, including 101,005 adults and 132 endophthalmitis cases.

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Clinical trial

2007 ESCRS group

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2007
Clinical trial

Use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis. {Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007 Jun;33(6):978-88.}

2.2. Post-operative topical antibiotics

High-certainty evidence shows that injection with cefuroxime with or without topical levofloxacin lowers the chance of endophthalmitis after surgery

Moderate-certainty evidence to suggest that using antibiotic eye drops in addition to antibiotic injection probably lowers the chance of endophthalmitis compared with using injections or eye drops alone.{Gower EW, Lindsley K, Tulenko SE, Nanji AA, Leyngold I, McDonnell PJ. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database Syst Rev. 2017 Feb 13;2(2):CD006364.}

3. Vitrectomy

Clinical trial

1995 EVS

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1995
Clinical trial

Routine immediate pars plana vitrectomy is not necessary in patients with better than light perception vision at presentation but is of substantial benefit for those who have light perception-only vision.{Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol. 1995 Dec;113(12):1479-96. PMID: 7487614.}

References

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