Topical antibiotics after routine cataract surgery

Dermot McGrath

Posted: Thursday, June 13, 2019

Alexander Silvester MD speaking at the 2019 SOE meeting in Nice, France.

Topical antibiotics are not necessary following routine cataract surgery and should not be systemically prescribed, according to the results of a large-scale study in the United Kingdom.
“There is little evidence or consensus for the benefit of topical antibiotics following routine cataract surgery, despite the fact that this remains common practice in the United Kingdom,” said Alexander Silvester MD at the 2019 European Society of Ophthalmology (SOE) meeting in Nice, France.
Systematic reviews and large national studies have found that topical postoperative antibiotics are not important in preventing endophthalmitis after cataract surgery when the patients have received intracameral antibiotics, noted Dr Silvester.
“Drug delivery to the tears is inherently inefficient and may be inadequate to eradicate bacteria, especially in the anterior chamber. However, there is evidence that overuse of antibiotics leads to resistance,” he said.
Dr Silvester’s retrospective study looked at 11,849 cataract operations performed at 10 hospitals in the United Kingdom between June 2018 and November 2018. The primary outcome measure was endophthalmitis rate and secondary outcomes were incidence of postoperative anterior uveitis, cystoid macular oedema, corneal oedema and visual harm defined as loss of more than three lines of vision.
Some 5,386 patients received a combination of topical corticosteroid and antibiotic drops postoperatively and 6,463 patients received topical corticosteroid only. All patients received intracameral antibiotics peri-operatively and all were reviewed four weeks post cataract surgery. No cases of endophthalmitis were reported in either group. There was also no significant difference between the groups found in rates of postoperative anterior uveitis, cystoid macular oedema, corneal oedema and visual harm.