Surgical prophylaxis for ophthalmic surgery

Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis).

The aim of antibiotic prophylaxis in ophthalmic surgery is to reduce acute postoperative endophthalmitis, a sight-threatening complication of intraocular surgery. All intraocular procedures may result in inoculation of the eye with organisms and subsequent infection. Prevention of endophthalmitis involves a combination of preoperative screening, antisepsis of the periocular area and ocular surface, intraoperative techniques (including correct wound construction and sealing), and postoperative patient care.

Active conjunctivitis, dacryocystitis or blepharitis must be treated and resolved before surgery.

After cataract surgery, intracameral administration (injection into the anterior chamber of the eye) of antibiotics at the end of surgery is considered the most effective method for reducing the risk of endophthalmitis. Use:

Seek expert advice for patients with cefazolin hypersensitivity. In patients hypersensitive to other cephalosporins, or to penicillins, cefazolin is often tolerated because it shares no common side-chains with other beta lactams (see Cross-reactivity between penicillins and cephalosporins).

The use of preoperative topical antibiotics does not provide additional benefit to the above interventions. Postoperative topical antibiotics, though widely prescribed, lack evidence; the rate of endophthalmitis was not increased in large cohort studies using intracameral antibiotics alone (without postoperative topical antibiotics).

If postoperative topical antibiotics are considered necessary, chloramphenicol is recommended; use:

There is a lack of evidence to support use of topical quinolones. Tobramycin does not have activity against Gram-positive organisms.