Posters

Meta-analysis of the role of topical antibiotics for prevention of acute endophthalmitis after cataract surgery

Poster Details

First Author: D.Romero-Valero SPAIN

Co Author(s):    J. Escolano Serrano   C. Monera Lucas   C. Fernández Martínez   J. Martínez Toldos           

Abstract Details

Purpose:

Endophthalmitis is a severe complication following cataract surgery and perioperative antibiotics are one of the main weapons for its prevention. Diverse pathways of application of antibiotics are commercially available for this aim (intracameral, periocular, systemic and topical). Topical antibiotics have been commonly used during the last decades for the prevention of endophthalmitis after cataract surgery. However, the evidence of this practice remains unclear. This meta-analysis aims to asses the role of topical antibiotics in the prevention of endophthalmitis after cataract surgery.

Setting:

Department of Ophthalmology, Elche’s University General Hospital. Statistics Department of the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (FISABIO).

Methods:

We searched PubMED (January 1999 to January 2020) for clinical trials or case series which compare the use of intracameral antibiotics vs. topical antibiotics and intracameral antibiotics. The main outcome was the occurrence of endophthalmitis in each group of treatment. We also searched PubMED for clinical trials comparing the use of topical povidone iodine plus topical antibiotics against povidone iodine alone at the preoperatory patient preparation. The rate of positive cultures at the time of the surgery was the main outcome for this analysis. The statistical analysis was performed with the programming language R (version 3.6.1 2019-07-05).

Results:

The number of articles included in the metanalysis was 10; with a total sample of eyes of 490.831. We found no significant differences in the rates of endophthalmitis with preoperatory (RR 0.0002 [IC95% 0.0002; 0.0003] vs RR 0.0002 [IC95% 0.0001; 0.0004] with and without topical antibiotics respectively) nor postoperative topical antibiotics (0.0003 [0.0002; 0.0003] vs. 0.0004 [ 0.0002; 0.0008]). No significant differences were found in the rate of positive cultures at the start of the surgery (RR 0.1283 [0.0572; 0.2629] vs. 0.1420 [0.0565; 0.3139]).

Conclusions:

We found little influence on the use of perioperative topical antibiotics in the rates of endophthalmitis and positive cultures. The recommendation for the use of topical antibiotics for the prevention of endophthalmitis after cataract surgery is weak. This evidence does not support the wide use of topical antibiotics among ophthalmologist for this aim. Further clinical trials are needed to enrich the available evidence on this topic.

Financial Disclosure:

travel has been funded, fully or partially, by a competing company