Endophthalmitis: Sterile unit cefuroxime dose needed

October 1, 2007

If a sterile unit dose of cefuroxime were available it would become the world standard for endophthalmitis prophylaxis following the startling proof of its efficacy in the ESCRS endophthalmitis study last year. That was the conclusion of a debate for and against intracameral antibiotics at the JCRS Symposium, Controversies in Cataract & Refractive Surgery.

Endophthalmitis: sterile unit cefuroxime dose needed

If a sterile unit dose of cefuroxime were available it would become the world standard for endophthalmitis prophylaxis following the startling proof of its efficacy in the ESCRS endophthalmitis study last year. That was the conclusion of a debate for and against intracameral antibiotics at the JCRS Symposium, Controversies in Cataract & Refractive Surgery.

"The risk of TASS from kitchen pharmacy, and the litigious nature of medical practice in the United States, means that cefuroxime is not the prophylaxis of choice there," said Randall Olson, of the John A. Moran Center in the US, speaking against intracameral injection.

Dr Olson pointed out that pre- and postoperative topical antibiotics provided good coverage, and he would like to see a study testing the efficacy of pre- and postoperative topical application of fourth-generation fluoroquinolones. He added that gram-positive resistance to cefuroxime is increasing.

Dr Barry rejoined that such a study would prove extremely expensive and would encounter ethical dilemmas given a proven, safe treatment already exists. "We're getting an incidence of just 0.05% of endophthalmitis cases with intracameral cefuroxime, showing the best proven prophylaxis for endophthalmitis. It is effective against the majority of the organism."

He added that there are also organisms resistant to fourth-generation fluoroquinolones such as the enterococci and staphylococcus aureus.

Dr Olson concluded that the two were largely in agreement. "If we had a sterile unit dose, intracameral cefuroxime would be the world standard prophylaxis."

New Acri.Tec monotoric bifocal lens takes to the stage

Continuing on the path of IOL innovation, Acri.Tec unveiled the latest offering from its family of lenses in the form of the monotoric bifocal Acri.LISA Toric 466 TD lens.

According to the company, the lens combines the strong, proven visual performance of the Acri.LISA bifocal lens in near, intermediate and distance vision with the reliable and stable astigmatic correction of the firm's Acri.Comfort bitoric lens.

The Acri.LISA Toric is monotoric with an aspheric toric front surface and an aspheric diffractive back surface with Acri.Tec's patented SMP technology. The lens can also be implanted through a 1.5 mm incision, and hence can be used to perform microincision cataract surgery.

Refractive surgery will disappear to be replaced by RLE

Dr Howard I. Fine told delegates that he was the best ophthalmic surgeon because none of his patients used glasses. He then showed the audience a video of 'patients', all wearing spectacles, drinking directly from bottles of wine. It was a lighted finish in keeping to the session's theme, "I am the best because. . .".

At the same time, Dr Fine did map out important and developing areas in refractive lens exchange (RLE), which he believes will mean that the procedure becomes the refractive intervention of choice.

"Cataract or lens extraction is incredibly safe and efficacious," he said. "It improves outcomes with lower energy, smaller incisions, adjunctive refractive techniques and increased accuracy and safety. It's evolved into a refractive surgery."

He noted there are limitations in LASIK, particularly for high hyperopes, high myopes and presbyopes and, and age-induced changes in the spherical aberration of patients' crystalline lens will mean further treatment will be necessary.

RLE, on the other hand, just keeps expanding, with many developing multifocal and accommodative options, like the Tecnis Multifocal (AMO), the Synchrony (Visiogen) and NuLens (NuLens) accommodative lenses, the Smart IOL (Medennium Inc.) and the Calhoun light adjustable lens (LAL) (Calhoun Vision). Other interesting technologies are just beginning to emerge, like the LiquiLens (Vision Solutions Technologies) or pixelate optics.