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 fluoro-
quinolone intracameral antibiotics (moxifloxacin and vancomycin are
the others). That landmark study documented a 5-fold decrease in
endophthalmitis rates, and many surgeons took notice.
"There's not much debate or controversy," says Kevin M. Miller, MD,
Kolokotrones Chair in Ophthalmology at the David Geffen School of
Medicine at UCLA. "The evidence is clearly in favor of injecting antibi-
otics. The literature is overwhelming."
Here's what you need to know about intracameral injections.
1. It's still not the standard of care. Because the FDA hasn't
approved intracameral injections for cataract surgeries, the antibiotics
are being used off-label. If your patient contracts an infection after an
intracameral injection and sues you, "you'll be held against the com-
munity standard of care" — what other local doctors use, says Dr.
Miller. If most of them aren't administering intracameral injections,
you might be open to liability.
Interestingly, many doctors feel compelled to use topical drops,
even though they're also off-label and their effectiveness is question-
able. "There's never been a study that shows that applying antibiotic
drops to the eye after surgery reduces the rate of endophthalmitis,"
says Dr. Miller. "But because it's so common, it's now the community
standard of care. So everybody does it, and if you don't, you're an out-
lier."
Until the FDA approves intracameral injections, the situation is unlike-
ly to change. A new U.S. study in development, dubbed TIME ("topical
versus intracameral moxifloxacin for endophthalmitis prophylaxis"),
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