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A Journal on Ophthalmology
Minerva Oftalmologica 2015 June-December;57(2-4):23-36
Endophthalmitis prophylaxis following cataract surgery
Brusasco L., Nuzzi R.
Università di Torino, Ospedale San Luigi di Orbassano, Regione Gonzole 10, Orbassano, Torino, Italia
Postoperative endophthalmitis is an uncommon (0.028-0.345% of cases) but potentially devastating intraocular infection that can occur after routine cataract surgery. Although a broad spectrum of organisms have been shown to cause acute postoperative endophthalmitis, most cases are caused by gram-positive bacteria, which may be introduced at the time of surgery from colonization of adjacent conjunctiva or eyelid skin. There are several antibacterial strategies employed to prevent postoperative endophthalmitis, with topical, intracameral and subconjunctival delivery being the most common. A retrospective analyzed of recent literature was conducted. Worldwide, there seems to be significant regional variance in the type and method of prophylactic antibacterial regimens; for example, topical fluoroquinolones are commonly used in the USA, while intracameral cephalosporins are employed widely in Europe after ESCRS Study of 2007. The most common cause of postcataract surgery endophthalmitis is gram-positive coagulase negative staphylococcus (CNS). The optimal antibacterial strategy for the prevention of endophthalmitis should be safe, inexpensive and broad in microbiological activity spectrum, while not requiring patient compliance for its effectiveness. Today, in most cases is the surgeon who, on the basis of his experience, decides the best prophylaxis and methodological strategy.