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  • Title: Infectious postoperative endophthalmitis after cataract surgery performed over 7 years. The role of azithromycin versus ciprofloxacin eye drops.
    Author: Tuñí-Picado J, Martínez-Palmer A, Fernández-Sala X, Barceló-Vidal J, Castilla-Martí M, Cartagena-Guardado Y, Grau S.
    Journal: Rev Esp Quimioter; 2018 Dec; 31(6):15-21. PubMed ID: 30421880.
    Abstract:
    OBJECTIVE: Although topical antibiotics have been used as antimicrobial prophylaxis after ocular surgery, recent studies have determined that intracameral cefuroxime at the end of surgery significantly reduce the risk to suffer an infection and suggest that the use of topical antibiotics in the prophylaxis of infectious postoperative endophthalmitis (IPOE) is controversial. Moreover, there is no evidence to confirm the higher effectiveness of topical ciprofloxacin, considered the standard of care, or topical azithromycin in preventing IPOE of cataract surgeries. METHODS: IPOE topical prophylaxis was performed with two different strategies: with azithromycin from January 1st, 2010 to December 31st, 2014 (group I) and with ciprofloxacin from January 1st, 2015 to January 31st, 2017 (group II). Patient characteristics and clinical signs and symptoms of IPOE from all consecutive cataract surgeries performed over a 7-year period were collected. RESULTS: A total of 15,146 cataract surgeries were conducted; 10,756 in group I and 4,390 in group II. Two cases of IPOE in each group were diagnosed, showing a 0.019% and 0.046% rate respectively, with no statistically significance. IPOE cases were related with aging, systemic and ocular comorbidities or with a complicated cataract surgery. CONCLUSIONS: The benefit of the application of topical antibiotics after cataract surgery is questionable when intracameral cefuroxime prophylaxis is performed and no better effectiveness with ciprofloxacin or azithromycin was observed. INTRODUCCIÓN: Aunque la aplicación de antibióticos tópicos se ha utilizado como profilaxis antibiótica tras cirugía ocular, estudios recientes han determinado que el uso de cefuroxima intracameral como profilaxis tras cirugía ocular ha reducido de forma significativa la aparición de infecciones y sugiere que el uso de antibióticos tópicos como profilaxis de endoftalmitis infecciosa post-operatoria (IPOE) es controvertido. Además, no existe evidencia que confirme la eficacia de ciprofloxacino tópico, considerado como la terapia estándar, o azitromicina tópica en la prevención de IPOE. PACIENTES Y MÉTODOS: La profilaxis tópica para prevenir la IPOE, se realizó siguiendo dos estrategias: azitromicina tópica en el periodo entre 1 enero de 2010 al 31 de diciembre de 2014 (Grupo I) y ciprofloxacino en el periodo entre 1 de enero de 2015 al 31 de diciembre de 2017 (Grupo II). Se recogieron las características de los pacientes y los signos y síntomas clínicos de IPOE de las cirugías realizadas durante los 7 años. RESULTADOS: Se realizaron un total de 15.146 cataratas: 10.756 en el Grupo I y 4.390 en el Grupo II. Se diagnosticaron dos casos de IPOE en cada grupo, presentando una tasa de 0,019% y 0,046% respectivamente, sin diferencias estadísticamente significativas. Los casos de IPOE se relacionaron con edad avanzada, comorbilidades sistémicas u oculares o con cirugías complicadas. CONCLUSIONES: El beneficio de la aplicación de antibiótico tópico después de cirugía de cataratas es cuestionable siempre que se realice profilaxis con cefuroxima intracameral y no se encontró una mayor protección con ciprofloxacino o con azitromicina
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