Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Information

DOI:
https://doi.org/10.1002/14651858.CD006364.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 13 February 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Eyes and Vision Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • Emily W Gower

    Correspondence to: University of North Carolina, Gillings School of Global Public Health, Chapel Hill, USA

    [email protected]

  • Kristina Lindsley

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

  • Samantha E Tulenko

    University of North Carolina, Gillings School of Global Public Health, Chapel Hill, USA

  • Afshan A Nanji

    Casey Eye Institute, Oregon Health & Science University, Portland, USA

  • Ilya Leyngold

    Division of Oculofacial Plastic and Reconstructive Surgery, Duke University Hospital Department of Ophthalmology, Durham, USA

  • Peter J McDonnell

    Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA

Contributions of authors

Conceiving the review: EG, AB, RC, IL, PM, SV.

Designing the review: EG, AB, RC, IL, PM, SV.

Coordinating the review: EG.

Data collection for the review:

  • Undertaking manual searches: EG, KL, IL, AN;

  • Screening search results: EG, KL, IL, RC, AN;

  • Organizing retrieval of papers: KL, AN;

  • Screening retrieved papers against inclusion criteria: EG, KL, IL, AN;

  • Appraising quality of papers: EG, KL, AB;

  • Extracting data from papers: EG, KL, IL, AN;

  • Writing to authors of papers for additional information: not applicable;

  • Providing additional data about papers: not applicable;

  • Obtaining and screening data on unpublished studies: not applicable.

Data management for the review:

  • Entering data into Review Manager 5: KL, EG.

Analysis of data: EG, KL.

Interpretation of data: EG, KL, AN, IL, PM.

Writing the review: EG, KL.

Securing funding for the review: PM.

Performing previous work that was the foundation of current study: AB, PM, EG.

Updating the review: EG, KL, ST, AN, IL, PM.

Sources of support

Internal sources

  • Discretionary funds, Wilmer Eye Institute, Johns Hopkins University, USA.

External sources

  • Cochrane Eyes and Vision US Project supported by grant 1 U01 EY020522, National Eye Institute, National Institutes of Health, USA.

  • National Institute for Health Research (NIHR), UK.

    • Richard Wormald, Co‐ordinating Editor for Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.

    • The NIHR also funds the CEV Editorial Base in London.

    The views expressed in this publication are those of the authors and not necessarily those of the NIHR, National Health Service, or the Department of Health.

Declarations of interest

EG: none known.
KL: none known.
ST: none known.
AN: none known.
IL: none known.
PM: none known.

Acknowledgements

We acknowledge Iris Gordon, Information Specialist for Cochrane Eyes and Vision (CEV), who designed strategies for and conducted the electronic searches. We acknowledge Niall Crosby, Barbara Hawkins, and Tianjing Li for their comments on the protocol and Lisa Herrinton, Neal Shorstein, and Barbara Hawkins for peer reviewing the original review.

We are grateful to Roy Chuck (RC), Ashley Behrens (AB), and Satyanarayana Vedula (SV) for their contributions to developing and publishing the protocol for this review.

Version history

Published

Title

Stage

Authors

Version

2017 Feb 13

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Review

Emily W Gower, Kristina Lindsley, Samantha E Tulenko, Afshan A Nanji, Ilya Leyngold, Peter J McDonnell

https://doi.org/10.1002/14651858.CD006364.pub3

2013 Jul 15

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Review

Emily W Gower, Kristina Lindsley, Afshan A Nanji, Ilya Leyngold, Peter J McDonnell

https://doi.org/10.1002/14651858.CD006364.pub2

2007 Jan 24

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery.

Protocol

Ilya Leyngold, Afshan A Nanji, Roy S Chuck, Ashley Behrens, Satyanarayana S Vedula, Peter J McDonnell, Emily W Gower

https://doi.org/10.1002/14651858.CD006364

Differences between protocol and review

We added methods for the assessment of the certainty of evidence and presentation of outcomes in a 'Summary of findings' table according to revised Cochrane standards.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Summary of findings for the main comparison. Perioperative antibiotics for prevention of endophthalmitis after cataract surgery

Perioperative antibiotics for prevention of endophthalmitis after cataract surgery

Population: participants undergoing cataract surgery

Settings: eye hospital or clinic

Outcome: risk of endophthalmitis after surgery

Perioperative prophylaxis versus no prophylaxis

Study ID

No. eyes and participants

Follow‐up

Comparison

(intervention vs comparator)

Risk of endophthalmitis by study group

RR (95% CI)
Treatment vs control

Certainty of the evidence
(GRADE)

Presumed cases*

Proven cases**

Presumed cases*

Proven cases**

Sobaci 2003

644 eyes of 640 participants

6 weeks

Treatment: BSS with antibiotics (vancomycin 20 mg/mL and gentamicin 8 mg/mL)

Not reported

0/322 (0%) eyes

Not reported

0.20 (0.01 to 4.15)

⊕⊝⊝⊝
Very low1,2

Control: BSS‐only irrigating infusion fluid

Not reported

2/322 (0.62%) eyes

ESCRS 2007

16,603 eyes of 16,603 participants

6 weeks

Treatment 1: combined intracameral cefuroxime and topical levofloxacin

2/4052 (0.05%) eyes

1/4052 (0.02%) eyes

0.14 (0.03 to 0.63)

0.10 (0.01 to 0.78)

⊕⊕⊕⊕
High

Treatment 2: intracameral cefuroxime 0.9%

3/4056 (0.07%) eyes

2/4056 (0.05%) eyes

0.21 (0.06 to 0.74)

0.20 (0.04 to 0.91)

⊕⊕⊕⊕
High

Treatment 3: topical levofloxacin 0.5%

10/4049 (0.25%) eyes

7/4049 (0.17%) eyes

0.72 (0.32 to 1.61)

0.70 (0.27 to 1.84)

⊕⊕⊕⊝
Moderate3

Control: placebo drops

14/4054 (0.35%) eyes

10/4054 (0.25%) eyes

Comparisons of combinations of antibiotics with specific antibiotics

Study ID

No. eyes and participants

Follow‐up

Interventions

Risk of endophthalmitis by study group

RR (95% CI)
Treatment 1 vs treatment 2

Certainty of the evidence
(GRADE)

Presumed cases*

Proven cases**

Presumed cases*

Proven cases**

Christy 1979

6618 eyes of 6618 participants

1 week

Treatment 1: combined prophylaxis (topical regimen + periocular penicillin at the time of surgery)

5/3309 (0.15%) eyes

Not reported

0.33 (0.12 to 0.92)

Not reported

⊕⊕⊕⊝
Moderate4

Treatment 2: topical regimen alone (chloramphenicol‐sulfadimidine)

15/3309 (0.45%) eyes

Not reported

ESCRS 2007

16,603 eyes of 16,603 participants

6 weeks

Treatment 1: combined intracameral cefuroxime and topical levofloxacin

2/4052 (0.05%) eyes

1/4052 (0.02%) eyes

Treatment 1 vs treatment 2: 0.67 (0.11 to 3.99)

Treatment 1 vs treatment 2: 0.50 (0.05 to 5.52)

⊕⊕⊕⊝
Moderate3

Treatment 2: intracameral cefuroxime 0.9%

3/4056 (0.07%) eyes

2/4056 (0.05%) eyes

Treatment 2 vs treatment 3: 0.30 (0.08 to 1.09)

Treatment 2 vs treatment 3: 0.29 (0.06 to 1.37)

⊕⊕⊕⊝
Moderate3

Treatment 3: topical levofloxacin 0.5%

10/4049 (0.25%) eyes

7/4049 (0.17%) eyes

Treatment 1 vs treatment 3: 0.20 (0.04 to 0.91)

Treatment 1 vs treatment 3: 0.14 (0.02 to 1.16)

⊕⊕⊕⊕
High

Mode of antibiotic delivery

Study ID

No. eyes and patients

Follow‐up

Interventions

Risk of endophthalmitis by study group

RR (95% CI)
Mode 1 vs mode 2

Certainty of the evidence
(GRADE)

Presumed cases*

Proven cases**

Presumed cases*

Proven cases**

Christy 1986

77,015 eyes of 77,015 participants

1 week

Mode 1: Anterior sub‐Tenon injections (subconjunctival)

38/39,752 (0.10%) eyes

Not reported

0.85 (0.55 to 1.32)

Not reported

⊕⊕⊕⊝
Moderate4

Mode 2: Posterior sub‐Tenon injections (retrobulbar)

42/37,263 (0.11%) eyes

Not reported

Cunha 2013

108 eyes of 108 participants

3 weeks

Treatment 1: fixed combination of topical gatifloxacin 0.3% and prednisolone acetate 1%

0/47 (0%) eyes

Not reported

0.43 (0.02 to 10.34)

Not reported

⊕⊝⊝⊝
Very low1,5

Treatment 2: individual instillation of topical gatifloxacin 0.3% and prednisolone acetate 1%

1/61 (2%) eyes

Not reported

GRADE Working Group grades of evidence
High‐certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate‐certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low‐certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low‐certainty: We are very uncertain about the estimate.

BSS: balanced salt solution; CI: confidence interval; RR: risk ratio.

*Presumed cases: includes both culture‐proven and clinically diagnosed cases of postoperative endophthalmitis.

**Proven cases: cases confirmed by at least one of Gram stain, culture, or polymerase chain reaction (PCR)

1 Downgraded for imprecision (‐2) as the study did not enroll a sufficient number of participants to detect differences between groups.

2 Downgraded for high risk of attrition bias (‐1) as the study authors excluded participants at the time of surgery based on the surgeon's discretion (number excluded not reported).

3 Downgraded for imprecision (‐1) as the confidence interval of the effect estimate between groups was wide.

4 Downgraded for indirectness (‐1) as the study was conducted more than 30 years ago and the techniques for cataract surgery have since changed substantially.

5 Downgraded for high risk of attrition bias (‐1) as the study authors excluded participants who did not return for follow‐up (16% of study population).

Figures and Tables -
Summary of findings for the main comparison. Perioperative antibiotics for prevention of endophthalmitis after cataract surgery
Table 1. Visual acuity following endophthalmitis

Comparisons of specific antibiotics or combinations of antibiotics

Study ID

Groups

Proportion of eyes with final VA > 20/40 following endophthalmitis

RR (95% CI)
Group 1 vs group 2

Proportion of eyes with final VA < 20/200 following endophthalmitis

RR (95% CI)
Group 1 vs group 2

Presumed cases*

Proven cases**

Presumed cases*

Proven cases**

Presumed cases*

Proven cases**

Presumed cases*

Proven cases**

ESCRS 2007

Group 1: intracameral cefuroxime injection, with or without topical levofloxacin drops

2/5 (40%) eyes

1/3 (33.3%) eyes

0.69 (0.22 to 2.11)

0.57 (0.11 to 2.95)

0/5 (0%) eyes

0/3 (0%) eyes

0.46 (0.03 to 7.48)

0.50 (0.03 to 7.54)

Group 2: no injection, with or without topical levofloxacin drops

14/24 (58.3%) eyes

10/17 (58.1%) eyes

4/24 (16.7%) eyes

4/17 (23.5%) eyes

CI: confidence interval; final VA: visual acuity at time of last follow‐up visit (range 3 weeks to 8 months); VA: visual acuity.

*Presumed cases: includes both culture‐proven and clinically diagnosed cases of postoperative endophthalmitis.

**Proven cases: cases confirmed by at least one of Gram stain, culture, or polymerase chain reaction (PCR).

Figures and Tables -
Table 1. Visual acuity following endophthalmitis