Antibiotics in intravitreal injection: what comes to cataract surgery?

Session Details

Session Title: Cataract Surgery Practice Styles

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 08:56

Venue: Boulevard B

First Author: : A.Grzybowski POLAND

Co Author(s): :    J. Pieczyński              

Abstract Details

Purpose:

To analyse and verify the evidance for antibiotic use in intravitreal injections and to consider results in cataract surgery practice

Setting:

Antibiotics have been used before and after intravitreal injections (IVI) as “a safe and effective” measure in prophylaxis against postinjection endophthalmitis for many years with no strong evidence, but mostly based on logic reasoning. The recent studies questioned this practice.

Methods:

We analysed PubMed platform to search for articles on post-IVI endophtalmitis and topical antibiotic prophylaxis as well as conjunctival flora and bacterial resistance in patients after IVI from 2003 to Febr 2014. (25 articles). We divided search results into three groups: 1. endophtalmitis and ivi (17 articles); 2. bacteria resistance and ivi (6 articles); 3. conjunctival bacteria flora and ivi (2 articles).

Results:

We found that post injection endophthalmitis rate in analysed studies ranged between 0,0% to 1,9%. There was no correlation between the topical antibiotic use and the protection against endophthalmitis. In some studies, cases of endophthalmitis appeared more often or only in the group with antibiotic use comparing to non-use groups. It was clearly shown that repeated use of antibiotics, changes the conjunctival flora and leads to increased rate of resistance to conjunctival flora.

Conclusions:

The study shows that in times of evidence based medicine logical reasoning practices might be inappropriate and should be verified. The use of topical antibiotics in cataract surgery is based on logical reasoning since there is no proven protection coming from this procedure against endophthalmitis. The use of antibiotics, if not justified, leads to unnecessary costs and global rise of bacterial antibiotic resistance, thus should be re-conisidered and verified.

Financial Interest:

NONE