Purpose: To determine the effects of antibiotic prophylaxis on the incidence of post operative
endophthalmitis following phaco emulsification and to identify risk factors. Setting: 24 ophthalmology units in Austria, Belgium, Germany, Italy, Poland, Portugal, Spain,
Turkey and the United Kingdom, with an administrative office in Ireland, co-ordinating
centre in England, and a data management and statistical unit in Scotland. Methods: From September 2003 until January 2006 a total of 16,603 patients were recruited
to the study which was prospective, randomised and partially masked. The study was
based on a 2×2 factorial design and the study objective factors were intracameral
cefuroxime and intensive perioperative topical levofloxacin drops. Results: 29 patients in total presented with acute postoperative endophthalmitis following
cataract surgery and 20 of these were proven by gram stain, culture, or PCR. The benefit
of intracameral cefuroxime as prophylaxis was overwhelming. The two principal risk
factors were the use of a clear corneal incision and the use of a silicone intraocular
lens. Intensive perioperative levofloxacin drops were not shown to be of benefit.
Conclusion: The use of intracameral cefuroxime prophylactically at 1mg in 0.1mls at the end of
surgery reduces the occurrence of postoperative endophthalmitis. The utilisation of
a clear corneal incision and the choice of a silicone intraocular lens both need to
be reconsidered.
