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Intracameral antibiotic prophylaxis following cataract surgery in Pakistan

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First Author: Y.Scantling-Birch UK

Co Author(s):    Y. Scantling-Birch   H. Naveed   B.    R. Zia           

Abstract Details

Purpose:

Cataract surgery is the most common intraocular surgery performed worldwide and endophthalmitis remains one of the most dreaded postoperative complications. Intracameral antibiotic prophylaxis has been shown to be highly effective at reducing the risk of endophthalmitis following cataract surgery. Despite the growing evidence and professional recognition for this gold standard practice, it has not been fully adopted globally, or in developing countries such as Pakistan. Our objective was to evaluate the uptake of intracameral antibiotics by ophthalmic surgeons in Pakistan.

Setting:

Nationwide eye centres, including teaching and training institutes, private practices and charity camps, in the major provinces of Pakistan.

Methods:

A prospective, descriptive, questionnaire-based study was conducted in Pakistan between September and November 2020. The voluntary, self-reported questionnaire was distributed via an emailing list registered with the British Pakistani Ophthalmic Society (BPOS) using a survey client (Survey Monkey, California, USA). The questionnaire was short and explored the uptake of intracameral antibiotics amongst ophthalmologists operating in Pakistan for endophthalmitis prophylaxis following cataract surgery. The questionnaire was validated and approved by senior ophthalmologists affiliated with BPOS.

Results:

A total of 246 respondents filled in the questionnaire. The questionnaire was representative of ophthalmologists working in the major provinces of Pakistan, from tertiary teaching centres to charitable organisations. Intracameral antibiotic prophylaxis accounted for less than half of current antibiotic practice during cataract surgery in Pakistan (n = 99, 40.3%). From this group, the majority (n = 54, 55.7%) used intracameral moxifloxacin only, which was prepared from commercially available eye drops (Vigamox®). The second most common practice was intracameral cefuroxime only (n = 21, 21.7%). The third most common practice was intracameral moxifloxacin plus dexamethasone (n = 12, 12.4%).

Conclusions:

Developing countries often lag behind the latest developments and guidelines in ophthalmic practice due to lack of infrastructure, funding and health policy. Pakistan has a diverse ophthalmic practice, varying from state-of-the-art cataract suites to non-sterile and resource depleted cataract camps. Intracameral antibiotic prophylaxis in cataract surgery is evidence-based and recommended by numerous professional bodies, including ESCRS. Health policy reform in developing nations, such as Pakistan, is required to promote a culture of evidence-based practice, national auditing and safer surgery.

Financial Disclosure:

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