Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Full citation: Gower EW, Lindsley K, Tulenko SE, Nanji AA, Leyngold I, McDonnell PJ. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD006364. DOI: 10.1002/14651858.CD006364.pub3

What is the aim of this review?
The aim of this Cochrane Review was to find out if using antibiotics at the time of cataract surgery can prevent bacterial infection of the eye (endophthalmitis) after cataract surgery. Cochrane researchers collected and analyzed all relevant studies to answer this question and found five studies.

Key messages
There is a very small chance of endophthalmitis after cataract surgery. Antibiotics injected into the eye during surgery lower this small chance of infection (high-certainty evidence). Antibiotic injection and antibiotic eye drops given together probably lower the chance of infection compared with using either injection alone or eye drops alone. Information on adverse effects was not provided in most studies.

What was studied in this review?
Endophthalmitis is a rare, but potentially serious, complication of cataract surgery that may lead to blindness. It is caused by bacteria that enter the eye during surgery or in the first few days after surgery. There are many ways to stop infection during and after surgery, such as using antibiotics at the time of surgery. There are several different types of antibiotic that can be used, and these may be used in different ways (either by injection into the eye, or infusion into the blood, or eye drops) or at different times (before, during, or after surgery).

What are the main results of the review?
Cochrane researchers found five relevant studies. Two studies were conducted in Pakistan, one study in several European countries, one study in Brazil, and one study in Turkey. These studies all looked at different treatments: one study compared four different treatments - antibiotic injection combined with antibiotic eye drops versus antibiotic injection alone versus antibiotic eye drops alone versus placebo eye drops; one study compared combined antibiotic injection and antibiotic eye drops versus antibiotic eye drops alone; one study compared combined antibiotics and steroids versus antibiotics and steroid given individually; one study compared two different locations for the antibiotic eye injection; one study compared adding antibiotics to the sterile fluid used during surgery versus not adding antibiotics to this fluid.
The review shows that:

  • Antibiotic injection in the eye (cefuroxime) at the end of surgery lowers the chance of endophthalmitis after surgery (high-certainty evidence).
  • Using antibiotic eye drops (either levofloxacin or chloramphenicol) in addition to antibiotic injection (either cefuroxime or penicillin) probably lowers the chance of endophthalmitis compared with using injections or eye drops alone (moderate certainty evidence).
  • It is very uncertain whether adding antibiotic to the sterile irrigating fluid used during cataract surgery lowers the chance of endophthalmitis (very low-certainty evidence).
  • It is very uncertain if using antibiotics and steroids individually or in combination makes a difference to the chance of developing endophthalmitis (very low-certainty evidence).
How up-to-date is this review?
The Cochrane researchers searched for studies that had been published up to December 2016.