Alfonso Arias-Puente

Effectiveness of intracameral cefuroxime in preventing endophthalmitis after cataract surgery Ten-year comparative study.

PURPOSE: To determine the differences in the endophthalmitis rates in cataract surgery before and after prophylactic use of intracameral cefuroxime. SETTING: University Hospital Fundación Alcorcón, Madrid, Spain. METHODS: This prospective study evaluated patients who had cataract surgery at a university eye center over a 10‐year period (1999 to 2008). Since the protocols approval by the Hospital Board in October 2005 to the end of the 10‐year period, cataract patients were routinely treated with prophylactic intracameral cefuroxime. A database was used to measure the occurrence of endophthalmitis postoperatively. Then, the incidence of endophthalmitis before and after generalized use of prophylactic cefuroxime was compared. The effect of cefuroxime was evaluated by the relative risk. RESULTS: From January 1999 to December 2008, 13 652 patients had cataract surgery. Forty‐two cases of postoperative bacterial endophthalmitis were reported. The endophthalmitis rate was 0.30% (95% confidence interval [CI], 0.26%‐0.35%) overall, 0.59% (95% CI, 0.50%‐0.70%) from January 1999 to September 2005, and 0.043% (95% CI, 0.02%‐0.06%) from October 2005 to December 2008. The relative risk was 0.07 (range 0.022 to 0.231; P<.05). CONCLUSION: Intracameral cefuroxime proved to be effective in reducing the risk for acute‐onset endophthalmitis after cataract surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Human aqueous humor levels of oral ciprofloxacin, levofloxacin, and moxifloxacin

Purpose: To evaluate the penetration of ciprofloxacin, levofloxacin, and moxifloxacin into the aqueous humor after oral administration. Setting: Alcorcon Hospital, Madrid, Spain. Methods: Forty‐two patients having cataract surgery were randomly divided into 3 groups the day before surgery. The first group received 2 oral 500 mg doses of ciprofloxacin at 12‐hour intervals. The second group received a single oral 500 mg dose of levofloxacin. The third group received a single oral 400 mg dose of moxifloxacin. At the time of surgery, 0.1 mL aqueous fluid was aspirated from the anterior chamber just before the operation and immediately stored at −80°C. Drug concentrations were measured using a biological assay. Results: The mean aqueous level of ciprofloxacin was 0.50 &mgr;g/mL ± 0.25 (SD); of levofloxacin, 1.50 ± 0.50 &mgr;g/mL; and of moxifloxacin, 2.33 ± 0.85 &mgr;g/mL. The mean aqueous levels of levofloxacin and moxifloxacin were above the 90% minimum inhibitory concentration for most of the common microorganisms that cause endophthalmitis. Conclusions: Therapeutic concentrations of fluoroquinolones, mainly levofloxacin and moxifloxacin, were reached with oral administration. These antibiotics may be effective for prophylaxis and adjuvant therapy of bacterial endophthalmitis.

In vitro adhesion of Staphylococcus epidermidis to intraocular lenses

Purpose: To compare the in vitro adherence of slime‐producing and non‐slime‐producing Staphylococcus epidermidis to different intraocular lenses (IOLs) to study the organisms contribution to postoperative endophthalmitis. Methods: Strains of slime‐positive (ATCC 35984) and slime‐negative (ATCC 12228) S epidermidis were used. The IOLs were made of poly(methyl methacrylate) (PMMA), PMMA with polypropylene haptics, silicone, hydrogel, acrylic, heparin‐surface‐modified (HSM) PMMA, and fluorine‐surface‐modified PMMA. The lenses were incubated overnight with bacteria, then sonicated and vortexed to separate the adhered bacteria. Quantitative cultures were performed and the results statistically analyzed. Results: Slime‐negative strains of S epidermidis adhered to all IOLs but at a lower level than slime‐positive strains. The most adherent lenses were acrylic with the positive strain and PMMA with the negative strain. The least adherent IOLs were PMMA with the positive strain and hydrogel with the negative strain. There were no significant differences between rigid and foldable lenses. Polypropylene was significantly more adherent than PMMA to the slime‐positive strain. The acrylic and the HSM PMMA IOLs were significantly more adherent to the positive strain. Conclusions: In vitro, there were significant differences in bacterial adhesion among IOL materials. Slime‐positive strains of S epidermidis were more adherent than slime‐negative ones.

Incidence of endophthalmitis and impact of prophylaxis with cefuroxime on cataract surgery

Purpose To evaluate the clinical and economic impact of prophylactic administration of intracameral cefuroxime on cataract surgery. Setting Hospital Universitario Fundación Alcorcón, Madrid, Spain. Design Quasi‐experimental study with before and after analysis. Methods The evolution of the cumulative incidence of endophthalmitis before and after (October 2005) administration of intracameral cefuroxime as endophthalmitis prophylaxis in cataract surgery was studied. The annual incidence adjusting to a Poisson distribution was compared. The effectiveness of the prophylaxis was evaluated with the relative risk (RR). The impact of cefuroxime was evaluated with the attributable risk fraction and the number of patients needed to treat to avoid a case of endophthalmitis. Results Cataract surgery was performed in 19 463 patients, 6595 patients before and 12 868 patients after October 2005. Endophthalmitis was diagnosed in 44 cases (39 before and 5 after). Positive microbiology cultures were obtained in 29 patients (66%). The overall cumulative incidence was 0.23 cases per 100 patients. Cefuroxime protected against endophthalmitis (RR = 0.06; P<.05; 95% confidence interval [CI], 0.03‐0.17); the impact or number needed to treat was 182, and the attributable risk fraction was −0.93% (P<.05; 95% CI, −0.82 to −0.97). The cost of a dose of cefuroxime was &U20AC;1, and the cost of a case of endophthalmitis was &U20AC;1358. The potential saving with cefuroxime was &U20AC;1177 for every 182 patients treated. Conclusion Intracameral cefuroxime reduced the incidence of endophthalmitis in cataract surgery and had a high clinical and economic impact on its prevention. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Adherence of two strains of Staphylococcus epidermidis to contact lenses.

Purpose. To compare the adherence of biofilm-producer and nonbiofilm-producer Staphylococcus epidermidis in vitro to different soft contact lenses (CLs) to study its possible contribution to the pathogenesis of keratitis. Methods. Strains of S. epidermidis slime-positive ATCC 35984 (biofilm-producer) and slime-negative ATCC 12228 (nonbiofilm-producer) were used with eight types of soft CLs from the four groups determined by the United States Food and Drug Administration (FDA), according to the ionicity and water content. The lenses were incubated overnight with the bacteria, then sonicated and vortexed to separate the adhered bacteria. Quantitative cultures were performed and the results statistically analyzed. Results. Slime-negative strains of S. epidermidis were able to adhere to all CLs but at a lower level than slime-positive strains. There were significant differences in bacterial attachment among the four FDA groups. On the whole, there was higher bacterial adhesion to nonionic and low-water content materials. Contact lenses produced by soft molding were less adherent than CLs produced by either lathe-cutting or spin-casting. Conclusions. Bacterial biofilm favors bacterial adhesiveness and colonization of soft CLs. Bacterial attachment was less in soft molding CLs (etafilcon A), which provide a more homogeneous and smoother surface.

Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens.

Purpose To evaluate clinical outcomes after the implantation of a diffractive trifocal intraocular lens (IOL). Setting Nine European ophthalmology centers. Design Prospective noncomparative interventional multicenter study. Methods The trifocal diffractive AT LISA tri 839MP IOL was implanted in eyes with bilateral cataract. Monocular and binocular visual performance was assessed as was the level of perceived photic phenomena, patient satisfaction, and spectacle dependence 1 month and 3 months postoperatively. Results The IOL was implanted in 208 eyes of 104 patients. The mean binocular uncorrected distance visual acuity improved from 0.44 logMAR ± 0.30 (SD) to 0.02 ± 0.10 logMAR and 0.03 ± 0.09 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected intermediate visual acuity (80 cm) improved from 0.51 ± 0.30 logMAR to 0.09 ± 0.13 logMAR and 0.10 ± 0.15 logMAR at 1 month and 3 months, respectively (P < .01). The mean binocular uncorrected near visual acuity improved from 0.67 ± 0.31 logMAR to 0.16 ± 0.14 logMAR and 0.15 ± 0.14 logMAR, respectively (P < .01). Among the more frequently perceived photic phenomena were halos; however, approximately 75% of patients were not bothered by them. More than 90% of patients were satisfied with the outcome. Spectacle independence at all distances was higher than 90%. Conclusion This IOL provided excellent visual outcomes and high refractive predictability at all distances, including intermediate, leading to high levels of patient satisfaction and spectacle independence. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Endoftalmitis tras cirugía de cataratas: epidemiología, aspectos clínicos y profilaxis antibiótica

PURPOSE To estimate the incidence of endophthalmitis after cataract surgery and to describe the main epidemiological and clinical data, as well as the role of intracameral antibiotics. METHODS A cross-sectional descriptive study was conducted on patients who underwent cataract surgery in a public hospital over an 11-year period. An ocular infection database was used to report endophthalmitis occurrences and to collect the clinical features. Qualitative variables are described with their frequency distribution and qualitative variables, with the mean and the standard deviation. RESULTS From January 1999 to December 2009, 15.173 patients underwent cataract surgery. A total of 43 patients suffered from postoperative endophthalmitis, giving an overall infection rate of 0.28% (95% CI: 0.20-0.36%). Among the 43 cases, there were 19 men and 24 women with a mean age of 78.5. Other clinical parameters evaluated were as follows: 25.58% were diabetic, 44.18% had some degree of immunosuppression and there were complications with posterior capsular tears in 18.6%. As regards antibiotic prophylaxis, 2 groups were considered: the first one did not receive intracameral antibiotic (8,099 patients) and the second group received intracameral cefuroxime (7,074 patients). There were 39 endophthalmitis in the first group with an infection incidence of 0.48% and 4 endophthalmitis in the second group with an infection incidence of 0.056%. The relative risk (RR) after-before cefuroxime was 0.12 (0.04-0.33) with P<0.05. CONCLUSIONS The incidence of endophthalmitis after cataract surgery in an 11-year period was lower than 0.3%. Almost half of the patients had a higher systemic risk. Intracameral cefuroxime resulted in nearly a 9-fold reduction in the rate of infection.