Careful preop, postop treatment needed to reduce endophthalmitis risk

Treating periocular conditions preoperatively, doing meticulous lid draping intraoperatively and using topical antibiotics postoperatively are several ways of reducing the risk of endophthalmitis following cataract surgery, a surgeon said.

"You want to make sure that your incision is watertight and you do meticulous surgery. You want to try to avoid complications as much as possible and start an antibiotic the same day," Francis S. Mah, MD, said at the OSN New York annual meeting.

Dr. Mah said Medicare has shown an increase in endophthalmitis cases following cataract surgery in recent years. Antibiotic resistance, wound leaks and self-sealing clear corneal incisions could be factors contributing to the increase, he said.

He cited data from a retrospective cohort study by Trevin Wallin, MD, and colleagues of 1,525 patients, 27 of whom had endophthalmitis. They found that incision leak was the most common risk factor for the infection, followed by surgical complications and antibiotics not started on the same day.

Dr. Mah recommended that physicians treat lid disease, sterilize the surface, use topical anti-infectives and povidone iodine, and suture when necessary to prevent infection. He said he does not yet use intracameral antibiotics because he requires better data regarding toxic anterior segment syndrome and reduced risk of anaphylaxis.