Rathi Varsha M, Sharma Savitri, Das Taraprasad, Khanna Rohit C
Allen Foster Research Centre for Community Eye Health, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute (LVPEI), Banjara Hills, Hyderabad, India.
Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, LVPEI, Hyderabad, India.
Indian J Ophthalmol. 2020 Nov;68(11):2451-2455. doi: 10.4103/ijo.IJO_1738_19.
Intracameral antibiotic in cataract surgery has shown level I evidence as prophylaxis for postoperative endophthalmitis. Not much is known if one should also use topical antibiotics after intracameral injection. The purpose of the study was to determine efficacy of intracameral antibiotic with and without postoperative topical antibiotic in reducing the incidence of acute endophthalmitis after cataract surgery in rural India.
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prospective comparative, non-randomized interventional study was designed in 15 rural centres in India. The study recruited 40,006 patients (n = 42,466 eyes), who underwent cataract surgery (phacoemulsification/small incision cataract surgery), and received intracameral antibiotic (cefuroxime/moxifloxacin). Postoperative topical antibiotic prescription was left to the choice of the treating physician, but they were encouraged not to use it in uneventful surgeries. Primary outcome measure was occurrence of acute clinical endophthalmitis within 6 weeks of surgery. Statistical analysis was done using STATA software v13.1 (StataCorp, Texas); P value of <0.05 was considered statistically significant.
In the study, 17,932 (42%) eyes received intracameral cefuroxime (ICC) and 24,534 (58%) eyes received intracameral moxifloxacin (ICM). Topical antibiotic was not prescribed to 17,855 (42%) eyes - 5723 (32%) eyes in ICC group and 12,132 (68%) eyes in ICM group. Acute clinical endophthalmitis occurred in 15 (0.035%) eyes - 1 / 3515 (0.028%) eyes and 1 / 2231 (0.045%) eyes that received and did not receive topical antibiotic, respectively. The difference in occurrence of endophthalmitis with/without topical antibiotics in each group (ICC: 0.016% and 0.017%; P = 0.958; ICM: 0.040% and 0.058%; P = 0.538) was not significant (P = 0.376).
Supplementing intracameral antibiotic with topical antibiotic postoperatively did not impact the occurrence of acute post cataract surgery endophthalmitis in rural India.
前房内注射抗生素在白内障手术中已被证明是预防术后眼内炎的I级证据。对于在前房内注射后是否也应使用局部抗生素，目前了解不多。本研究的目的是确定在前房内注射抗生素的基础上，加用或不加用术后局部抗生素，对降低印度农村白内障手术后急性眼内炎发生率的效果。
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在印度15个农村中心设计了一项前瞻性比较、非随机干预研究。该研究招募了40006例患者（42466只眼），他们接受了白内障手术（超声乳化/小切口白内障手术），并接受了前房内抗生素（头孢呋辛/莫西沙星）。术后局部抗生素的处方由治疗医生决定，但鼓励他们在手术顺利的情况下不使用。主要结局指标是术后6周内发生急性临床眼内炎。使用STATA软件v13.1（StataCorp，德克萨斯州）进行统计分析；P值<0.05被认为具有统计学意义。
在该研究中，17932只眼（42%）接受了前房内头孢呋辛（ICC），24534只眼（58%）接受了前房内莫西沙星（ICM）。17855只眼（42%）未开具局部抗生素处方——ICC组5723只眼（32%），ICM组12132只眼（68%）。急性临床眼内炎发生在15只眼（0.035%）——分别为接受和未接受局部抗生素的1/3515只眼（0.028%）和1/2231只眼（0.045%）。每组中使用和未使用局部抗生素的眼内炎发生率差异（ICC：0.016%和0.017%；P=0.958；ICM：0.040%和0.058%；P=0.538）无统计学意义（P=0.376）。
在印度农村地区，白内障手术后在前房内注射抗生素的基础上加用局部抗生素，对急性眼内炎的发生没有影响。
