• Vol. 36 No. 10, S40–S44
  • 15 October 2007

Prophylaxis Against Endopthalmitis in Cataract Surgery

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ABSTRACT

Introduction: Endophthalmitis is an uncommon but potentially devastating complication of cataract surgery and often carries a poor prognosis. The incidence of endophthalmitis varies considerably in the literature, ranging from 0.05% to 0.35%. Some measures routinely used as prophylaxis have not been proven to be of benefit. This article reviews the current literature on the common prophylactic measures used to prevent endophthalmitis. Methods: A search of the literature in Medline and critical review of the study design, sample size, and analysis of outcomes. Results: Clinical studies on prophylactic measures suggest that using povidone-iodine 5% to clean the eyelids and conjunctiva before cataract surgery has a significant benefit both in reducing the actual rate of endophthalmitis and reducing the bacterial load after surgery. A bolus dose of intracameral cefazolin or cefuroxime has a significant benefit on reducing infection rate, with evidence for the latter drug coming from a large, prospective, randomised clinical trial. There is some evidence to suggest that subconjunctival antibiotics may reduce the incidence of endophthalmitis, although much of the evidence comes from case-control studies. Although the current evidence on the efficacy of topical antibiotic drops is mixed, this is commonly practiced both pre- and postoperatively. Conclusions: The most useful prophylactic measures to reduce the rate of endophthalmitis are the use of 5% povidone-iodine and intracameral injection of antibiotics after surgery. Subconjunctival antibiotics may be of benefit, while topical antibiotics alone may not reduce the rate of endophthalmitis significantly.


Endophthalmitis is an uncommon but potentially devastating complication of cataract surgery and often carries a poor prognosis. Due to variations in study design and methods of data collection, as well as real differences in incidence among various centres, the reported rates of endophthalmitis vary considerably, ranging from 0.05% to 0.35%.1-6 Ophthalmic surgeons have adopted various measures to reduce the incidence of postoperative endophthalmitis, although the evidence of the efficacy of some of these measures is not well established. This article reviews the current literature on the common prophylactic measures used to prevent endophthalmitis.

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