Archive June 2019 XX, No. 6

5 Things to Know About Intracameral Antibiotics

They appear to be more effective than topical prophylaxis for preventing endophthalmitis, but they're still not approved by the FDA.

Joe Paone

Joe Paone


Steve Arshinoff, MD, FRCSC
EASY ON THE EYES Intracameral injections can reduce endophthalmitis rates and eliminate the need for patients to apply post-op drops — but it's all being done off-label.

Cataract surgeons continue to live somewhat dangerously in their efforts to prevent the rare but dangerous infection of post-op endophthalmitis. Topical prophylaxis remains the community standard of care, but an ever-growing number of surgeons feel intracameral injections of antibiotics are more effective. But while that method has largely been embraced in Europe, it presents a dilemma for U.S. ophthalmologists.

Intracameral injections still aren't FDA-approved — and don't appear likely to be any time soon — so their off-label use at this time could violate community standards of care. In addition, pharmaceutical companies have shown little interest in providing single-use, sterile intracameral antibiotics, so the drugs must be compounded. All this leaves eye surgeons at a crossroads where using superior post-cataract infection prevention potentially exposes them to medical and legal risk.

It all began with an oft-cited 2007 European Society of Cataract & Refractive Surgery (ESCRS) study that described the effectiveness of intracameral injection of a second-generation cephalosporin known generically as cefuroxime, 1 of the 3 prominent fourth-generation fluoroquinolone intracameral antibiotics (moxifloxacin and vancomycin are the others). That landmark study documented a 5-fold decrease in endophthalmitis rates, and many surgeons took notice.

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