Endophthalmitis and Cataract Surgery
Endophthalmitis and Cataract Surgery
Endophthalmitis is one of the most feared complications after intraocular surgery; prophylactic antibiotics are part of the regimen to prevent this occurrence. The recent availability and use of fourth-generation topical fluoroquinolones may have an impact on the rate of this complication.
Moshirfar M, Feiz V, Vitale AT, Wegelin JA, Basavanthappa S, Wolsey DH
Ophthalmology. 2007;114:686-691
From March 2003 to July 2005, 20,013 surgeries were included in this retrospective analysis. Patients were treated preoperatively with either gatifloxacin 0.3% or moxifloxacin 0.5% every 15 minutes, 3 times, 1 hour before surgery. Postoperatively the same drop was used 4 times per day for a week. Anti-inflammatory medications were used at the discretion of the surgeon. Eighty-one percent of patients received gatifloxacin and 19% used moxifloxacin. There were 14 cases of acute postoperative endophthalmitis: 9 with gatifloxacin and 5 with moxifloxacin. Estimated rates of infection were 0.1% for moxifloxacin and 0.06% for gatifloxacin.
The overall rate of endophthalmitis of 0.07% does not differ from that in other reports. Although in vitro studies demonstrated improved spectrum of fourth-generation fluoroquinolones compared with third-generation drugs, this 'in-vivo' study showed no clinical difference. Given that these newer drugs do not offer additional protection compared with older antibiotics, it might be worthwhile to consider using 'older' antibiotics such as third-generation fluoroquinolones and reserve the newer antibiotics for frank infections. This in turn might save us from rapid development of resistant organisms to the newer drugs.
Abstract
Introduction
Endophthalmitis is one of the most feared complications after intraocular surgery; prophylactic antibiotics are part of the regimen to prevent this occurrence. The recent availability and use of fourth-generation topical fluoroquinolones may have an impact on the rate of this complication.
Endophthalmitis after Uncomplicated Cataract Surgery With the Use of Fourth-Generation Fluoroquinolones -- A Retrospective Observational Case Series
Moshirfar M, Feiz V, Vitale AT, Wegelin JA, Basavanthappa S, Wolsey DH
Ophthalmology. 2007;114:686-691
Summary
From March 2003 to July 2005, 20,013 surgeries were included in this retrospective analysis. Patients were treated preoperatively with either gatifloxacin 0.3% or moxifloxacin 0.5% every 15 minutes, 3 times, 1 hour before surgery. Postoperatively the same drop was used 4 times per day for a week. Anti-inflammatory medications were used at the discretion of the surgeon. Eighty-one percent of patients received gatifloxacin and 19% used moxifloxacin. There were 14 cases of acute postoperative endophthalmitis: 9 with gatifloxacin and 5 with moxifloxacin. Estimated rates of infection were 0.1% for moxifloxacin and 0.06% for gatifloxacin.
Comments
The overall rate of endophthalmitis of 0.07% does not differ from that in other reports. Although in vitro studies demonstrated improved spectrum of fourth-generation fluoroquinolones compared with third-generation drugs, this 'in-vivo' study showed no clinical difference. Given that these newer drugs do not offer additional protection compared with older antibiotics, it might be worthwhile to consider using 'older' antibiotics such as third-generation fluoroquinolones and reserve the newer antibiotics for frank infections. This in turn might save us from rapid development of resistant organisms to the newer drugs.
Abstract