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In pediatric procedures, surgeon recommends intracameral antibiotics, steroids
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KIAWAH ISLAND, S.C. — For safety and compliance reasons, one surgeon speaking here has committed to intracameral injections of steroids and antibiotics in all of his pediatric ophthalmic surgery cases.
“I started with uveitis pediatric patients and stopped using oral steroids in all cases, and I have been doing this now in all cases for the past about 2 years,” M. Edward Wilson, MD, said in a presentation at Kiawah Eye 2012.
Dr. Wilson said that there are obvious compliance issues for parents with using drops postoperatively in children of all ages, and even with compliant cases, the amount of actual drug delivery between intracameral injections and postoperative drops is tremendous.
“My goal as a pediatric ophthalmologist is to eliminate drops entirely postoperatively,” Dr. Wilson said.
He said the regimen was a must for endophthalmitis prevention, because despite preoperative topical antibiotics and povidone iodine use, 24.1% of anterior chamber cultures tested after cataract surgery showed positive bacterial growth.
Dr. Wilson cited studies that showed that four drops of moxifloxacin produced therapeutic levels of medication only up to 1.9 µg/mL in the anterior chamber, and one drop every 10 minutes for 2 hours only brought levels up to 2.3 µg/mL. Conversely, a 250 µg dose of moxifloxacin produced a concentration of 710 µg/mL to 1,250 µg/mL.
Dr. Wilson also cited studies showing the safety and tolerability of unpreserved moxifloxacin, out of the bottle. He uses a 50-50 mixture of unpreserved moxifloxacin with balanced salt solution.
“Intracameral administration of medications will become more and more important in pediatric intraocular surgery,” Dr. Wilson said. “Intracameral administration of meds reduces systemic side effects, allows lower doses to be used, and reduces the dependence on parental compliance after surgery.”
- Disclosure: Dr. Wilson receives grant support from Alcon Labs.