Evidence on the prevention of postoperative endophthalmitis
- Author:
Verzosa Lee
;
Oh Vanessa
- Publication Type:Journal Article
- MeSH:
PHACOEMULSIFICATION, VANCOMYCIN, POVIDONE-IODINE
- From:
Philippine Journal of Ophthalmology
2005;30(2):85-87
- CountryPhilippines
- Language:English
-
Abstract:
CLINICAL SCENARIO: An 82-year-old female with no apparent ocular problems, except fora brunescent cataract, underwent phacoemulsification with intraocular-lens (IOL) implantation. Postoperative medication consisted solely of antibiotic-steroid eye drops. One day after uneventful surgery, the patient developed severe pain, poor vision, and redness in the operated eye. Visual acuity was counting fingers at 1 meter. The eye had ciliary injection, grade 4 flare and cells, a small hypopyon, fibrin extending from the corneal wound, and a mildly edematous cornea. Intraocular pressure (IOP) was 24 mm Hg. Exudates behind the IOL were noted, but visualization was poor. Anterior-chamber and vitreous taps revealed gram-positive cocci. Could the ophthalmologist have prevented this complication? CLINICAL QUESTION: Among patients undergoing cataract extraction, what is the most effective regimen that can reduce the risk of endophthalmitis? SEARCH METHOD: A Medline search was performed using the keywords "endophthalmitis," "cataract," and "prevention." The search was limited to randomized controlled trials (RCT). No studies were found that compared endophthalmitis rates using different perioperative prophylactic measures. Most studies reported used substitute outcome measures such as periocular bacterial load, intraocular penetration of antibiotics, and anterior-chamber contamination. After reviewing the abstracts, only one RCT was considered relevant to the clinical question CITATION: Soto AM, Mendivil MP. The effect of topical povidone-iodine, intraocular vancomycin, or both on aqueous humor cultures at the time of cataract surgery. Ophthalmol 2001; 131:293-300. (Author)
