ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery : Data, Dilemmas and Conclusions 2013.
Endophthalmitis is a serious complication of cataract
surgery that every ophthalmic surgeon - and patient -
strives to avoid. The visual loss and debilitation that occur
in a large proportion of postoperative endophthalmitis
cases can be severe and irreversible. Those most in need
of the operation are often those at greatest risk, such as
the elderly. Without knowing exactly how, when or why to
intervene with effective prophylactic measures, virtually
every surgeon today follows a standard of care that involves
antisepsis and antibiotics.
Although cataract surgery ranks among the most frequently
performed surgical procedures worldwide, data to define
the most effective prophylactic measures have been nearly
impossible to generate, given the large patient numbers
needed to conduct clinical trials. Prevention and elimination
of postoperative endophthalmitis, however, is a constant
goal of every ophthalmic surgeon.
The clinical practice of administering a direct intracameral
injection of cefuroxime at the close of cataract surgery
to reduce endophthalmitis rates was first implemented
by a group of Swedish surgeons, to whom this edition
of the Guidelines is dedicated. The clinical benefit of
this intervention seemed apparent. In order to test the
hypothesis in a scientific manner, the European Society
of Cataract and Refractive Surgeons mounted a large
randomized clinical trial to evaluate the intracameral
injection in a prospective, randomized fashion across
nine European countries. Results published in 2007
unequivocally demonstrated a clinical benefit, with a
five-fold reduction in postoperative endophthalmitis rates
in patients who received a 1mg intracameral injection of
cefuroxime at the close of cataract surgery1
.
