A Japanese Survey of Perioperative Antibiotic Prophylaxis in Cataract Surgery

Survey of Japanese ophthalmic surgeons regarding perioperative disinfection and antibiotic prophylaxis in cataract surgery

Purpose

To elucidate Japanese trends for perioperative disinfection and antibiotic selection during cataract surgeries.

Methods

Perioperative iodine use and antibiotic prophylaxis for cataract surgery were surveyed in eight regions in Japan by mail or through interviews from February 1 to March 1, 2014.

Results

We surveyed 572 surgeons, of whom 386 (67%) responded. Most of the surgeons (94%) used iodine compounds before surgery for periocular skin disinfection (povidone–iodine [PI]: 79%; polyvinyl alcohol-iodine [PAI]: 15%) or conjunctival disinfection (85%; PI: 36%; PAI: 49%). Preoperative conjunctival iodine was primarily used as an eye wash (irrigation: 95%) and less often as an eye drop (5%). It was determined that 31% of surgeons waited 30 seconds or more between periocular disinfection and conjunctival disinfection. During surgery, 14% of surgeons used iodine several times, including immediately before intraocular lens insertion, and 7% used the Shimada technique (repeated iodine irrigation). Preoperative antibiotic eye drops were used by 99% of surgeons, and antibiotics were added to the irrigation bottle by 22%. The surgeons reported use of subconjunctival antibiotic injections (23%), antibiotic ointments (79%), and intracameral antibiotics (7%: 22 moxifloxacin; 6 levofloxacin). All surgeons prescribed postoperative eye drops, with 10% initiating the drops on the day of surgery.

Conclusion

Iodine compounds are commonly used preoperatively, but few institutions use iodine compounds intraoperatively, particularly with repeated application. The selection of antibiotic administration and disinfection technique has to be at the surgeon’s discretion. However, intracameral antibiotic and intraoperative iodine compound use are techniques that should be widely recognized.

Efficacy and safety of prophylactic intracameral moxifloxacin injection in Japan

PURPOSE

To report endophthalmitis rates after cataract surgery and the incidence of complications after intracameral moxifloxacin injection.

SETTING

Nineteen clinics in Japanese institutions.

DESIGN

Retrospective survey cohort study.

METHODS

The number of surgeries and endophthalmitis cases in the past 4 years before and after the introduction of intracameral moxifloxacin was evaluated. The survey was performed by mail or interview in February 2013.

RESULTS

All institutions used total-replacement administration rather than small-volume injection. At 3 institutions, 50 to 100 μg/mL moxifloxacin; at 9 institutions, 100 to 300 μg/mL moxifloxacin; and at 7 institutions, 500 μg/mL moxifloxacin was administered. The highest concentration (500 μg/mL) was administered in 14,124 cases. Endophthalmitis cases occurred 1 month or sooner postoperatively in 8 of 15,958 cases (ie, 1 in 1955) without intracameral moxifloxacin administration and in 3 of 18,794 cases (ie, 1 in 6265) with intracameral moxifloxacin administration.

CONCLUSIONS

Intracameral moxifloxacin (50 to 500 μg/mL) administration decreased the risk for endophthalmitis by 3-fold. In more than 18,000 cases, moxifloxacin administration of 500 μg/mL or less did not result in severe complications, such as toxic anterior segment syndrome or corneal endothelial cell loss.