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   Table of Contents      
LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 4  |  Page : 603

Comment on: Antibiotic prophylaxis in cataract surgery – An evidence-based approach


1 Department of Ophthalmology, Ophthalmological Foundation of Santander; Centro Oftalmológico Virgilio Galvis, Floridablanca; Department of Ophthalmology, Faculty of Health Sciences, Autonomous University of Bucaramanga UNAB, Bucaramanga, Santander, Colombia
2 Department of Ophthalmology, Faculty of Health Sciences, Autonomous University of Bucaramanga UNAB, Bucaramanga, Santander; Department of Research, Ophthalmological Foundation of Santander, Floridablanca, Colombia
3 Department of Ophthalmology and Research, Faculty of Health Sciences, Autonomous University of Bucaramanga UNAB, Bucaramanga, Santander, Colombia

Date of Web Publication26-Mar-2018

Correspondence Address:
Dr. Alejandro Tello
Centro Oftalmológico Virgilio Galvis, Calle 158 20 – 95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander
Colombia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1309_17

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How to cite this article:
Galvis V, Tello A, Camacho PA, Rey JJ. Comment on: Antibiotic prophylaxis in cataract surgery – An evidence-based approach. Indian J Ophthalmol 2018;66:603

How to cite this URL:
Galvis V, Tello A, Camacho PA, Rey JJ. Comment on: Antibiotic prophylaxis in cataract surgery – An evidence-based approach. Indian J Ophthalmol [serial online] 2018 [cited 2019 Sep 22];66:603. Available from: http://www.ijo.in/text.asp?2018/66/4/603/228469



Dear Sir,

We read with interest the article by Haripriya on intracameral antibiotic prophylaxis.[1] Due to the complexity of a clinical trial addressing this issue, it is very improbable that a new one will be carried out.[1],[2] Furthermore, as Javitts stated and Haripriya reaffirmed, with the current observational evidence, to assign a patient to the group without intracameral antibiotic could be even ethically questionable.[1] However, a group of American researchers insist that at least two clinical trials are necessary to make a decision.[2]

Recent cumulative evidence taken only from two very large recent observational studies, including the enormous number of almost 7.5 million eyes, unquestionably indicates that intracameral antibiotics are effective [Table 1].[1],[3] We have also had a positive experience with intracameral moxifloxacin, initially using undiluted Vigamox ® (Alcon) beginning in 2007, and from 2013 undiluted Vigadexa ® (Alcon), with zero cases of acute postoperative endophthalmitis.[4] We have had, however, two patients with chronic endophthalmitis. We wonder if Haripriya has also seen cases of chronic postoperative intraocular infection following cataract surgery in eyes with intracameral antibiotics.
Table 1: Two of the largest retrospective studies on intracameral antibiotic prophylaxis for cataract surgery

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We agree with Haripriya and Kovesdy and Kalantar-Zadeh that not always several clinical trials are strictly necessary to gather enough evidence in a medical issue.[1],[5] To deny the growing body of evidence on the protective effect of cefuroxime and moxifloxacin administered by intracameral route, merely because no new randomized clinical trials have been made, is too simplistic. Due to these inflexible opinions, it could take a very long time for some ophthalmologists to accept this evidence, until retrospective studies including tens of millions of eyes confirm it again. The sad consequence will be that, meanwhile, hundreds of patients will present this complication without having been able to take advantage of the possibility of reducing their risk with the use of these intracameral antibiotics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Haripriya A. Antibiotic prophylaxis in cataract surgery – An evidence-based approach. Indian J Ophthalmol 2017;65:1390-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Galvis V, Tello A, Berrospi RD, Camacho PA, Rey JJ. Re: Schwartz et al.: Intracameral antibiotics and cataract surgery: Endophthalmitis rates, costs, and stewardship (Ophthalmology 2016;123:1411-1413). Ophthalmology 2017;124:e30-1.  Back to cited text no. 2
[PUBMED]    
3.
Creuzot-Garcher C, Benzenine E, Mariet AS, de Lazzer A, Chiquet C, Bron AM, et al. Incidence of acute postoperative endophthalmitis after cataract surgery: A Nationwide study in France from 2005 to 2014. Ophthalmology 2016;123:1414-20.  Back to cited text no. 3
[PUBMED]    
4.
Galvis V, Tello A, Sánchez MA, Camacho PA. Cohort study of intracameral moxifloxacin in postoperative endophthalmitis prophylaxis. Ophthalmol Eye Dis 2014;6:1-4.  Back to cited text no. 4
    
5.
Kovesdy CP, Kalantar-Zadeh K. Observational studies versus randomized controlled trials: Avenues to causal inference in nephrology. Adv Chronic Kidney Dis 2012;19:11-8.  Back to cited text no. 5
[PUBMED]    



 
 
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