Presented at European Society of Cataract & Refractive Surgery Conference at Barcelona, September 2009.
Perioperative antibiotic prophylaxis during phaco-emulsification and intraocular lens implantation: national survey of smaller eye units in England
Article first published online: 2 MAR 2010
© 2010 The Authors. Journal compilation © 2010 Royal Australian and New Zealand College of Ophthalmologists
Clinical & Experimental Ophthalmology
Volume 38, Issue 5, pages 462–466, July 2010
How to Cite
Nanavaty, M. A. and Wearne, M. J. (2010), Perioperative antibiotic prophylaxis during phaco-emulsification and intraocular lens implantation: national survey of smaller eye units in England. Clinical & Experimental Ophthalmology, 38: 462–466. doi: 10.1111/j.1442-9071.2010.02279.x
- Issue published online: 6 JUL 2010
- Article first published online: 2 MAR 2010
- Received 14 September 2009; accepted 12 January 2010.
- cataract surgery;
- intraocular lens
Purpose: To evaluate the commonest routinely used perioperative antibiotic, the preferred route of administration and the choice of antibiotic in ‘penicillin allergy’ by consultant ophthalmic surgeons in England.
Methods: A postal survey was conducted, between December 2008 and April 2009, among consultant ophthalmic surgeons working in smaller National Health Service Ophthalmic departments in England. Smaller units were defined by having a maximum of eight consultant surgeons and tend to be based in district general hospitals. The questionnaires were sent to all consultant ophthalmic surgeons irrespective of special interests. The three questions asked were: (i) Which antibiotic(s) do you use routinely for phaco-emulsification and intraocular lens implantation? (ii) What is your usual route of administration? and (iii) Which antibiotic(s) do you use when the patient states that they have ‘penicillin allergy’?
Results: The questionnaire was sent to 401 consultant ophthalmic surgeons and 262 consultants (65.34%) replied. Further analysis showed, 44.7% used only intracameral cefuroxime, 31.7% used only subconjunctival cefuroxime, 2.3% used only subconjunctival gentamicin, 6.9% used subconjunctival gentamicin or cefuroxime, 0.4% used subconjunctival cefotaxime, 0.4% used subconjunctival ceftazidime and 0.8% used no antibiotic prophylaxis. One hundred and three (37%) used cefuroxime in patients allergic to penicillin and 47% switched to gentamicin in this situation.
Conclusion: Routine phaco-emulsification and intraocular lens implantation is the commonest elective surgical procedure undertaken in the National Health Service and yet there is a wide variation in the use of prophylactic antibiotics in patients with or without ‘penicillin allergy’ despite The European Society of Cataract and Refractive Surgeons recommendations in 2007. Less than half of the surgeons working in smaller ophthalmic units routinely used intracameral cefuroxime and in ‘penicillin allergy’ only one-third used cefuroxime. This survey highlights the reluctance of using cefuroxime in patients allergic to penicillin despite evidence to the contrary.