Endophthalmitis Prophylaxis: Different Practices from Around the World
Endophthalmitis remains a serious and potentially blinding complication of all intraocular procedures. Visual outcomes vary widely, and the prognosis remains guarded even when treatment is started quickly and appropriately. Prophylaxis remains the most im
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Endophthalmitis Prophylaxis: Different Practices from Around the World Victor M. Villegas, Stephen G. Schwartz, Andrzej Grzybowski, Nidhi Relhan, and Harry W. Flynn Jr.
Endophthalmitis remains a serious and potentially blinding complication of all intraocular procedures. Visual outcomes vary widely, and the prognosis remains guarded even when treatment is started quickly and appropriately. Prophylaxis remains the most important strategy to decrease morbidity associated with this disease [1]. Practices that reduce the risk of endophthalmitis vary extensively between nations because of the limited data from randomized clinical trials (RCTs). Povidone-iodine preparation prior to any surgical procedure in non-allergic patients is a worldwide-accepted strategy that reduces endophthalmitis incidence (Fig. 29.1) [2]. This is the only technique to achieve category II evidence. Mostly considered controversial, chlorhexidine is currently used in some centers in patients with iodine allergy. However, chlorhexidine is toxic to the corneal endothelium and chlorhexidine prophylaxis has not been validated for intraocular surgery. Generally, the most likely causative organisms may be predicted based on the procedure (Table 29.1) [3–5]. For example, in the USA, the most common isolates from acute-onset postoperative endophthalmitis following cataract surgery are coagulase-negative staphylococci, whereas endophthalmitis following intravitreal injection is more commonly associated with more virulent organisms such as streptococci [4, 5]. Different isolates are more prevalent in different parts of the world. In addition, local standards of care vary widely, especially with respect to the use of prophylactic antibiotics. The present chapter will discuss different prophylaxis techniques that are practiced around the world for cataract surgery and for intravitreal injections.
V.M. Villegas • S.G. Schwartz, M.D., M.B.A (*) • N. Relhan • H.W. Flynn Jr. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA e-mail: [email protected] A. Grzybowski Department of Ophthalmology, Poznan City Hospital, Poznan, Poland University of Warmia and Mazury, Olsztyn, Poland © Springer Nature Singapore Pte Ltd. 2018 T. Das (ed.), Endophthalmitis, https://doi.org/10.1007/978-981-10-5260-6_29
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Fig. 29.1 Photograph demonstrating the “prep” for cataract surgery. Note the surgical drape, eyelid speculum, and evidence of povidone-iodine (Image courtesy of Guillermo Amescua, MD)
By definition, acute-onset postoperative endophthalmitis occurs within 6 weeks of the procedure, while delayed-onset (chronic) postoperative endophthalmitis occurs more than 6 weeks following the procedure.
Cataract Surgery The incidence of endophthalmitis after cataract surgery may differ depending on multiple factors including patient demographics, surgeons, instruments, techniques, and unknown factors. Large series have reported rates of acute-onset postoperative endophthalmit
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