Pressurizing, hydrating protocol reduces endophthalmitis rate
COPENHAGEN, Denmark — Pressurizing and hydrating the eye with vancomycin and balanced salt solution in association with ofloxacin pledgets was effective in reducing post-cataract endophthalmitis to one case in 13,658 operations at an ophthalmology department in Colorado.
"We were impressed by the European rate of post-cataract endophthalmitis with the use of cefuroxime and decided to perform interventions to reduce the rate in our organization," Lee Schelonka, MD, said at the meeting of the European Society of Ophthalmology.
Two interventions were performed. The first one, between 2001 and 2005, used povidone-iodine surface disinfection pledged with ofloxacin or gatifloxacin topically before surgery and then vancomycin 20 mg/mL in balanced salt solution irrigation. The second one, between 2006 and 2012, encompassed pressurizing the eye and hydrating the incision with vancomycin solution.
Vancomycin was used because "it has the lowest grade of resistance among gram-positive endophthalmitis organisms, in contrast to fluoroquinolones," Schelonka said.
He also noted that irrigation was used rather than intracameral injection because it was safer. Any concentration error, contamination of the solution or substances that could cause toxic anterior segment syndrome would be dilated in 500:1 irrigation solution rather than be injected into the eye.
"Since hydrating the incision with plain [balanced salt solution] reduces vancomycin concentration, we decided to hydrate and pressurize using the vancomycin solution," Schelonka explained.
The endophthalmitis rate before the study was 1.55 per 1,000 cases. The first intervention led to a rate of 0.4 per 1,000 cases, which was similar to the rate found in the ESCRS Endophthalmitis Study.
"But when we started hydrating and pressurizing the eye with the vancomycin solution, we only had one case in 7 years and no case in the past 4 years," Schelonka said.
Disclosure: Schelonka has no relevant financial disclosures.