Minimizing the risk of endophthalmitis following cataract surgery: current antibiotic approaches

IntroductionCataract surgery is the most commonly performed intraocular surgery in the world. Endophthalmitis is a sight-threatening complication subsequent to intraocular procedures, open-globe injuries, metastatic systemic infections, and systemic inflammatory diseases. The incidence of post-cataract surgery endophthalmitis is 0.012% to 1.3%.Areas coveredPatients' ocular surface flora, surgical instruments, and surgical complications like posterior capsule rupture with vitreous loss and anterior vitrectomy. The most common bacteria causing post-cataract endophthalmitis in the Western world are gram-positive coagulase-negative Staphylococci, followed by Streptococci and Pseudomonas aeruginosa. Povidone-iodine (PI) is the only topical prophylactic antiseptic known to reduce endophthalmitis perioperatively with a three to five times reduction rate within 1 min of irrigation. The European Society of Cataract & Refractive Surgeons (ESCRS) study recommendations are also discussed.Expert opinionThere are no randomized controlled trials of PI with endophthalmitis rate as the primary end point. Based on retrospective data, 5% PI applied to conjunctiva prior to surgery reduced endophthalmitis rates four-fold. Intracameral injection of either vancomycin, cefazolin, cefuroxime, or moxifloxacin has a prophylactic effect. We recommend using preoperative 5% povidone-iodine for 30 s in the cul-de-sac and intracameral moxifloxacin or cefuroxime as effective prophylaxis against post-operative endophthalmitis.