Intracameral antibiotics are a win for cataract surgery prophylaxis

By Vanessa Caceres;Reviewed by Francis Mah, MD

Intracameral antibiotics for prophylaxis during cataract surgery are a safe and effective option compared with a topical or transzonular approach, said Francis S. Mah, MD.

“It’s a timely topic,” said Dr. Mah, director of cornea and external diseases; co-director of refractive surgery, Scripps Health, La Jolla, CA. “Right now, there’s a lot of discussion about drug delivery, compliance, and drug costs. A lot of surgeons are looking for better options.”

Counterpoint: Transzonular approach to antibiotic delivery during cataract surgery is preferable

The interest in intracameral antibiotics as prophylaxis against infection began with the first published studies in the early 1990s by Per Montan, in Europe, Dr. Mah said. “Over time, they’ve gained in momentum,” he said. “There is study after study proving their efficacy, including large studies in the United States showing that intracameral antibiotics are superior to what we have historically done, which is use a topical approach.”

Many efficacy studies

Dr. Mah pointed out that there are many studies showing that intracameral antibiotics are superior to topicals in terms of efficacy. “In addition, intracameral antibiotics are a clear solution at the conclusion of surgery,” he added. “Therefore, patients can see just as well as after conventional surgery.”

Another advantage is that there is no learning curve with intracameral administration for cataract surgeons. Dr. Mah contrasted intracameral antibiotics with the newer transzonular approach.

“Right now, the transzonular approach is a wait-and-see,” Dr. Mah said. “It’s another interesting way of administering drugs to the eye, improving compliance, and possibly lessening endophthalmitis risk, but the jury is still out in saying it’s superior to topicals or intracamerals.”

Clouded vision

Dr. Mah also argued that a transzonular approach includes a suspension steroid that can potentially cloud the vision for days to weeks, and it has the potential for changing the effective lens position (ELP). “There are some case reports on the ELP changing because of the medications being placed into the anterior vitreous,” he said.

Ultimately, intracameral antibiotics improve efficacy and the patient experience by reducing their cost and instructions. They also help surgeons have confidence that they are using the most effective means of infection prevention, without relying on patient compliance, Dr. Mah concluded.

“Everyone is in the same boat of trying to improve the patient experience, reduce overall health care expense, and yet improve outcomes,” he said.

Francis S. Mah, MD

p. 585-554-7996

e: Mah.Francis@scrippshealth.org

This article is adapted from a presentation that Dr. Mah delivered at the 2017 American Society of Cataract and Refractive Surgery. Dr. Mah has financial interests with Allergan, Bausch & Lomb, Novartis, Ocular Science, and PolyActiva.