MATERIAL AND METHODS
This prospective randomized controlled clinical trial was conducted from September 2012 to November 2013 and included patients who underwent microincision cataract surgery (MICS) at the Hospital Virgen de los Lirios. The study recruited 60 eyes of 41 patients. Eligible patients were those aged 65 to 80 with senile cataract and no other concomitant disease that would prevent a postoperative best corrected visual acuity (BCVA) of 20/40 or better. Exclusion criteria included history of ocular surgery or trauma, corneal disease, glaucoma, uveitis, vitreous opacities, retinopathy or visual pathway defects. Other exclusion criteria were current treatment with systemic steroids, immunosuppressants, anticoagulants or prostaglandin analogue eye drops. Patients with intraoperative complications or extended surgical time were also excluded.
After informed consent was obtained, participants with history of allergy to penicillin were assigned to the vancomycin group (Group 1). An equal number of patients were selected at random and assigned to the control group (Group 2). Information gathered from patients included date of birth, sex, history of drug allergy and systemic diseases, medication use and surgeon. Patients in Group 1 received an intracameral injection of vancomycin (1 mg in 0.1 ml), whereas those in Group 2 received an intracameral injection of cefuroxime (1 mg in 0.1 ml). Vancomycin injection was prepared from the commercially available vancomycin hydrochloride 500 mg powder (Combino Pharm SL, Barcelona, Spain) and diluted with balanced salt solution (BSS®, Alcon Cusí, Barcelona, Spain) to a 1 mg/0.1ml solution. Likewise, cefuroxime injection was prepared from cefuroxime 750 mg powder (Laboratorios Ramón Sala SL, Barcelona, Spain) and diluted to a 1 mg/0.1ml solution. Age, sex, uncorrected visual acuity (UCVA), refraction, BCVA, average macular thickness and retinal thickness in the 9 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors (Figure 1)10 were evaluated and compared between groups. Postoperative examiner was blinded to the group assignment.
Pupils were dilated with repeated doses of tropicamide 1% (Colircusí Tropicamida®; Alcon Cusí, Barcelona, Spain) and phenylephrine 10% (Colircusí Fenilefrina®; Alcon Cusí, Barcelona, Spain). Preoperative prophylactic measures consisted of skin preparation with povidone-iodine 10% (Betadine®; Meda Pharma, Madrid, Spain), and instillation of povidone-iodine 5% into the conjunctival sac at the operating site at least 5 minutes before surgery. A combination of topical tetracaine 1% and oxybuprocaine 4% (Colircusí anestésico doble®; Alcon Cusí, Barcelona, Spain) was used as anesthesia. Surgery was performed by one of two surgeons (JJPS, ECM) using a standard phaco chop technique in all cases. All eyes were implanted with hydrophobic acrylic intraocular lenses (IOLs) AcrySof SN60WF (Alcon Laboratories,...