Adherence to European Society for Cataract and Refractive Surgery Recommendations among Italian Cataract Surgeons: A Survey

Endophthalmitis: a bibliometric study and visualization analysis from 1993 to 2023

Aims

This study is designed to generalize and depict the research hotspots of endophthalmitis through bibliometric methods and software and analyze the evolutive tendency of the work on this severe disease over the past 30 years.

Methods

This study employed a rigorous bibliometric approach. We identified all endophthalmitis-related literature by conducting a comprehensive search of the Science Citation Index Expanded database under the Web of Science Core Collection. The data was then analyzed and visualized using CiteSpace and VOSviewer, two widely recognized software tools in the field of bibliometrics. CiteSpace was used to analyze the country distributions, dual map overlay of journals, keyword bursts, and co-cited references. VOSviewer was employed to describe the authors and co-cited authors, the journals, the co-cited journals, and the keywords co-occurrence network. This robust methodology ensures the reliability and validity of the study's findings.

Results

A total of 2960 publications, including 2695 articles and 265 reviews, were included in this bibliometric study. There has been no shortage of endophthalmitis-related publications since 1993, with an apparent upward trend during recent years. Possible correlations with the COVID-19 pandemic are also analyzed. These studies were finished by 11,048 authors from 75 countries worldwide, with the United States in the lead. In the keyword co-occurrence network, except for the endophthalmitis term, cataract surgery becomes the keyword with the highest frequency. Different categories of endophthalmitis, including postoperative, post-injection, post-traumatic, and endogenous endophthalmitis, and antibacterial and anti-inflammatory therapies of infectious endophthalmitis, are discussed by categories. From the perspective of the timeline, postoperative and post-injection endophthalmitis were the dominant forms before and after the year 2000, respectively. Co-citation analyses reveal that the Endophthalmitis Vitrectomy Study (EVS) conducted in 1995 provides pivotal guidance for later research. Diverse pathogenic bacteria (e.g., Coagulase-negative Staphylococci, Propionibacterium acnes, Viridians Streptococci, and Bacillus cereus) or fungi (e.g., Candida, Aspergillus, and Fusarium) contribute to varying treatment principles and clinical prognosis, which should be taken seriously. In addition, intravitreal and intracameral antibiotics are the mainstay for treating and preventing infectious endophthalmitis, respectively.

Conclusion

Our bibliometric analysis provides an overview of dynamic evolution and structural relationships in the research field of endophthalmitis. The displayed hotspots and developmental directions have reference values for future investigation.

Expert consensus on the management of patients undergoing cataract surgery: A Delphi study

PURPOSE

To define the management of patients undergoing cataract surgery.

SETTING

Panel of experts on cataract surgery and members of the Italian Association of Cataract and Refractive Surgery (AICCER) participated in the Delphi study.

DESIGN

A restricted panel of experts defined the statements concerning the topic and identified a larger panel of experts who voted the statements. The statements concerned a series of practical issues concerning the management of patients undergoing cataract surgery.

METHODS

An initial web round-table served to develop the statements. The larger panel was constituted by 15 experts which anonymously voted the statements, presented in a web platform, using a 5- point Likert scale. Consensus was defined as at least 80% of agreement.

RESULTS

All participants completed the questionnaire. Globally, the total percentage of agreement of all statements was 90.4%. The total mean score was 4.5. Score 4 and score 5 accounted for the 27% and the 68% of the total votes, respectively.

CONCLUSIONS

The participants felt they could largely agree with and approve the statements proposed by the board. In addition, the Delphi study identified some points that are highly shared and endorsed. In particular, a new model approach can be based on a seven-day course using a fixed high-potency corticosteroid combination with a broad-spectrum antibiotic. At the end of this cycle, the patient should be re-evaluated in some way to continue any treatment in the most appropriate and personalized way possible.

Antibiotic prophylaxis for cataract surgery - Practice patterns amongst Indian Ophthalmologists

Purpose

To assess the current trends in use of perioperative antibiotic prophylaxis, especially intracameral antibiotics (ICAB), for cataract surgery in India.

Methods

This was an E-survey using a previously validated questionnaire carried out by the All India Ophthalmological Society (AIOS) in August 2022. An E-mail invitation to complete an online 40-point survey was sent to all members of the AIOS using a digital E-mail service (Survey Monkey) and social media platforms.

Results

Out of 1804 total respondents, 58% (n = 1022) reported using routine ICAB prophylaxis. Of those using ICAB, 89% (n = 909) reported using it for all cases, whereas the rest used it for specific indications such as post-PC rent (n = 43), one eyed patient (n = 19), and high-risk cases (n = 50). Commercially available moxifloxacin was by far the commonest agent used for ICAB (n = 686, 67%). Eighty respondents (8%) reported noticing occasional toxic reactions and nontoxic corneal edema (n = 64, 6%) with ICAB. Surgeons with >10 years' experience especially practicing in medical colleges used fewer ICAB (OR = 0.52, 95%CI = 0.38 - 0.72, P < 0,001) compared to younger surgeons (<5-year experience) in solo clinics. The commonest reason for nonadoption of IC antibiotics was "unconvinced of the need to use it in my setting" (n = 296, 52% of those who answered this question).

Conclusion

IC antibiotic prophylaxis for cataract surgery has significantly increased in India from 40% in 2017 to 58% in 2022. Commercially available moxifloxacin was preferred by the majority users. Intraocular inflammation may occur occasionally and needs safer formulations to avoid this.

Management of patients undergoing cataract surgery: An Italian survey

PURPOSE

To investigate the management of patients undergoing cataract surgery in Italy.

SETTING

Italian ocular surgeons, members of the Italian Association of Cataract and Refractive Surgery (AICCER), were invited to participate to this survey.

DESIGN

Participants had to respond to a questionary including a series of practical questions concerning the management of patients undergoing cataract surgery.

METHODS

A designed questionnaire explored the main issues concerning the practical problems involved in managing patients undergoing cataract surgery. The questionnaire was sent by e-mail and analyzed by descriptive statistics.

RESULTS

Preoperative prophylaxis was performed by most surgeons. After surgery, several products were used, even simultaneously. Fixed antibiotic-corticosteroid combination (87.2%; 89) and NSAIDs (88.2; 90) were chosen as the most commonly used drug classes. The average duration of prescribed post-surgical therapies was more than two weeks for 52.9% (54) of participants, two weeks for 29.4% (30), and only one week for 5.9% (6).

CONCLUSION

This survey confirmed a discrete adherence to the main guidelines but at the same time highlights a discrete inhomogeneity in the use of medications, duration of treatments, and follow-up visits. For this reason, it is appropriate to continue updating and implementing the guidelines and educational pathways. This thought is consistent with the Precision Medicine approach. Every patient should be carefully evaluated to determine the best medication, dosage, and duration. A Personalized Medicine strategy is used on a single patient to optimize treatment clinical efficacy while minimizing side effects.

Safety and Tolerability of an Eye Drop Based on 0.6% Povidone-Iodine Nanoemulsion in Dry Eye Patients

Purpose: To evaluate safety and tolerability on the ocular surface of an anti-septic formulation containing 0.6% povidone–iodine (0.6% PVI) for a 4 week period.

Methods: An observational, prospective study included 20 mild-moderate dry eye disease (DED) patients who enrolled at the Ocular Surface Disease Unit of the University of Messina, receiving 0.6% PVI eye drops for 28 days, 2 drops twice daily (BID). The assessment included the Ocular Surface Disease Index questionnaire; symptoms score (0 = absent to 3 = severe) for burning, ocular dryness, foreign body sensation, watery eyes, tearing, photophobia, and ocular pain; fluorescein tear break-up time (TBUT); and corneal-conjunctival staining, performed at baseline (T0), after 7 (T7) and 28 (T28). Schirmer I-test, corneal endothelial cell count, intraocular pressure, and fundus examination were performed at T0 and T28. The main outcome measures were TBUT and corneal-conjunctival staining as markers of ocular surface homeostasis. For statistical analysis, Student's T-test and Wilcoxon test were used as appropriate.

Results: No significant alterations of the safety parameters were found throughout the study. Further, at T28 a significant improvement of burning, ocular dryness, foreign body sensation, and watery eyes (T0 vs. T28 P < 0.03) were observed; corneal-conjunctival staining improved at T28 (T0 vs. T28 P < 0.0001), and TBUT improved already at T7 (T0 vs. T7 P = 0.0008) lasting so till the end of the study. The only adverse event was mild burning at instillation for the first 3 days of treatment in most of the patients.

Conclusions: The treatment with 0.6% PVI was safe and well tolerated in a group of patients with a damaged ocular surface.

Post-surgical management of cataract: Light and dark in the 2020s

Cataract surgery is the most frequently performed elective surgery worldwide. Although considered a safe procedure, potentially sight-threatening adverse events are possible. Among these, post-surgical inflammation and infections are the most relevant. Anti-inflammatory drugs, such as corticosteroids, and topical antibiotics are the pillars for the treatment of inflammation and for the prevention of infections. However, uncertainties remain regarding the duration of both topical antibiotic prophylaxis and corticosteroid treatment. LEADER7, a recent international clinical study conducted with the new fixed combination of levofloxacin and dexamethasone eye drops in patients undergoing uncomplicated cataract surgery, found that 1-week topical antibiotic prophylaxis is just as effective as the 2-week course commonly used in clinical practice. The study also showed that treatment for 1 week with dexamethasone results in complete resolution of inflammatory signs and symptoms in over 85% of patients, for whom further prolongation of corticosteroid treatment is, therefore, not necessary. This new treatment strategy can represent a significant step forward to reduce the unjustified use of prophylactic antibiotics after cataract surgery, limiting the emergence of bacterial resistance, as well as representing an opportunity to optimize the use and safety of the corticosteroid treatment.

Endophthalmitis after cataract surgery: Effect of behind-the-lens washout

PURPOSE

To analyze the outcomes of cataract surgery with emphasis on the relationship between surgery-related factors and the incidence of postoperative infectious endophthalmitis.

SETTING

Ninety-three surgical sites in Japan.

DESIGN

Prospective case series.

METHODS

Eyes that were scheduled to have cataract surgery from January 20 to September 30, 2014, were included. Phacoemulsification and implantation of a single-piece hydrophobic acrylic foldable intraocular lens (IOL) were performed. Patients were followed for 2 months.

RESULTS

Of the 9720 eyes enrolled, 9100 (93.6%) completed a 2-month follow-up. Three cases (0.033%) developed infectious endophthalmitis (95% confidence interval [CI], 0.000-0.070). The incidence of endophthalmitis was significantly associated with the removal method of ophthalmic viscosurgical devices (OVDs) after IOL implantation. The incidences of endophthalmitis in cases with and without the behind-the-lens technique were 0% (0/6147; 95% CI, 0%) and 0.084% (3/3570; 95% CI, 0.000-0.179), respectively, with a significant difference between them (P = .050, Fisher exact test). The incidence of infectious endophthalmitis did not correlate with any other patient-related and surgery-related factors.

CONCLUSION

The behind-the-lens technique to wash and clear the capsular bag for OVD removal significantly reduced the incidence of infectious endophthalmitis.

Choosing wisely and the use of antibiotics in ophthalmic surgery: There is more than meets the eye

BACKGROUND:

One of the directions of modern ophthalmology is toward an odontoiatric model, and new settings of eye care are becoming the standard of care: one day surgery and also office-based therapies.

METHODS:

Retrospective analysis of three tertiary-care centers in Italy and analysis of the literature.

RESULTS:

We provide readers with state-of-the-art measures of prophylaxis in ophthalmic surgery.

DISCUSSION AND CONCLUSION:

Role of antibiotics is criticized in the light of stewardship antimicrobial paradigm.

Vancomycin in infusion during vitrectomy in surgical treatment of acute postoperative and posttraumatic endophthalmitis

Background

Endophthalmitis is potentially devastating intraocular inflammation following eye trauma or surgery. We describe the visual outcomes and causative pathogens in acute bacterial postoperative and posttraumatic endophthalmitis treated with immediate pars plana vitrectomy (PPV) with Vancomycin dissolved in the infusion fluid.

Methods

Clinical records of consecutive 30 patients with postoperative endophthalmitis and 15 patients with posttraumatic endophthalmitis were evaluated. Vancomycin was administered constantly in the infusion fluid at the time of complete PPV. Cultures were prepared from anterior chamber paracentesis. The mean follow-up period was 13 months.

Results

The visual acuities were improved in 38 cases (84 %) and remained stable in seven cases (16 %). Median post-PPV visual acuity was 1.0 logMAR in a group with postoperative endophthalmitis and 1.3 logMAR in a group with posttraumatic endophthalmitis (p < 0.05). Twenty cases (44 %) were culture-positive (Staphylococcus, Streptococcus, Enterococcus and Bacillus spp).

Conclusions

Early PPV with Vanomycin in infusion leads to vision improvement in patients with both posttraumatic and postoperative endophthalmitis. In our series of 45 cases culture was positive only in half of the cases.