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Macular Thickness Changes After Intracameral Injection Of Vancomycin In Cataract Surgery.

1146 words - 5 pages

Intraoperative contamination of the anterior chamber is one of the most relevant factors suggested to be involved in postoperative endophthalmitis. Anterior chamber aspirates obtained during cataract surgery show contamination rates ranging from 2 to 43%,11,12 most commonly isolated microorganisms being Propionibacterium acnes and other conjunctival flora. Advances in prophylaxis measures, such as the use of preoperative povidone-iodine antisepsis have significantly reduced the rates of endophthalmitis.

The use of intracameral antibiotics gained worldwide acceptance since the ESCRS study demonstrated the effectiveness of intracameral cefuroxime in preventing postoperative endophthalmitis.2 However, the administration of cefuroxime in patients with documented allergies to penicillin is still a matter of controversy. It has been suggested that a breakdown in the blood-aqueous barrier influenced by postoperative inflammation could lead to an anaphylactic reaction, although only one case has been reported in the literature.13 Alternative antibiotic agents include moxifloxacin and vancomycin, the first being a fourth-generation fluoroquinolone with consistent efficacy and favorable safety profile.5,6 Vancomycin, on the other hand, is a frequent choice for intracameral prophylaxis in the USA and Europe,8 but its retinal safety has not been fully evaluated. Due to the fact that the EMA has not approved moxifloxacin for intracameral use after cataract surgery, vancomycin remains the preferred therapeutic alternative to cefuroxime in some european countries.

Our objective was to evaluate the effect of intracameral injections of vancomycin after cataract surgery on retinal thickness and functional outcome. Although fluorescein angiography (FA) has been the gold standard technique for detection of retinal damage following uneventful cataract surgery,14 there is a strong tendency toward the use of more reproducible techniques such as SD-OCT.15 In contrast to FA, OCT is a noninvasive, fast and highly sensitive technique to obtain both qualitative and quantitative analysis of the retina. Since its introduction in the early 1990s, it has been considered the standard method for measuring retinal thickness and macular abnormalities. Its principle is analogous to ultrasound B mode imaging except that it uses reflections of infrared light waves rather than sound waves. It combines broad bandwidth light sources with interferometric detection techniques, therefore providing high resolution images. As a qualitative analysis method, OCT images are used to identify and monitor structural changes of the retina. Quantitative analysis is based on the ability to identify the nerve fiber layer (NFL) and retinal pigment epithelium (RPE) and measure the distance between both layers, which provides an excellent estimate of retinal thickness.

Antcliff et al.16 reported a sensitivity of 96% and a specificity of 100% for the detection of CME using a conventional time-domain...

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