Chang highlights new trends in antibiotic prophylaxis for endophthalmitis
WAIKOLOA, Hawaii — Just past the 15-year anniversary of the cefuroxime ESCRS trial, debate regarding antibiotic prophylaxis for endophthalmitis after cataract surgery continues.
“When you have something controversial, it's nice to see what our colleagues are doing,” David F. Chang, MD, said at Hawaiian Eye 2022.
To that end, surveys of ASCRS members conducted in 2007, 2014 and 2021 published in the Journal of Cataract and Refractive Surgery compare trends in endophthalmitis prophylaxis over time. In the latest survey, of approximately 1,200 respondents, 76% were from the U.S.
In the 2021 survey, 66% of respondents said they use intracameral injection compared with 30% of respondents in the 2007 survey.
"What's clear now is that everyone is injecting this directly,” Chang said. Ninety-five percent of 2021 respondents who used intracameral injections said they used direct injection rather than an irrigation bottle to deliver antibiotics.
The 2021 survey shows a decrease in the use of topical prophylaxis both preoperatively and postoperatively since 2007, from 88% to 73% and from 98% to 86%, respectively.
For respondents using intracameral antibiotics, the most used drug is moxifloxacin, an increase from 31% in 2014 to 83% in 2021. Use of vancomycin decreased from 52% to 6% in the same period.
“This is a strong reversal from the last survey,” Chang said, attributing the acute increase in use of moxifloxacin in the U.S. to the association that has been made between vancomycin and hemorrhagic occlusive retinal vasculitis.
“Of those using intracameral antibiotic, one out of four has stopped using a topical at the same time,” Chang said of the latest survey.
As many as 50% said they might stop using a topical antibiotic if an approved commercial agent was available.
“To no surprise,” 80% of respondents feel that it is important to have a commercially available antibiotic for direct intracameral injection, and 93% said they would use an intracameral antibiotic if it was commercially available for a reasonable cost, Chang said.
"[Endophthalmitis] is, of course, a rare complication but because it can be devastating, medicolegal considerations always enter into the decision making,” Chang said. “I think that's where a survey can be helpful, because you can see that if you're using a compounded drug or taking it directly from the Vigamox [Novartis] bottle, you do have lots of company."
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Chang DF. Endophthalmitis prophylaxis practice patterns. Presented at: Hawaiian Eye; Jan. 15-21, 2022; Waikoloa, Hawaii.
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