Adherence to European Society for Cataract and Refractive Surgery recommendations among italian cataract surgeons: A survey

Purpose: To survey the surgical routines with regards to prophylactic strategies in a sample of Italian hospitals and compare these with European Society for Cataract and Refractive Surgery (ESCRS) guidelines.Methods: Six private and 18 public hospitals were included in this clinical-based retrospective study.The overall volume of cataract operations in the 24 centers in 2013 was 43,553.Main outcome measure was incidence of endophthalmitis per 1,000.An incidence of less than 0.13% was considered acceptable.Results: Our study provides the first Italian data on the use of intracameral antibiotics in cataract surgery as recommended by the ESCRS.Thirteen centers (54%) used intracameral cefuroxime at the end of surgery.Of the 13 centers that used cefuroxime, 8 (62%) had an incidence of endophthalmitis less than 0.13%.Of the 7 (29%) centers that did not use intracameral cefuroxime, all had an endophthalmitis rate of greater than 0.13%.This difference was statistically significant (p<0.05).Among the 4 centers not included, 2 used vancomycin in the infusion bottle, 1 a fluoroquinolone, and the last a combination of antibiotics.The majority of surgeons (71%) used preoperative antibiotic eyedrops, but this measure was not shown to be significantly protective.Conclusions: Slightly more than half of the centers surveyed in this study adhered to the recommendations of the ESCRS and routinely employed prophylactic intracameral cefuroxime.An incidence of endophthalmitis greater than 0.13% was encountered significantly more frequently among centers that did not employ intracameral cefuroxime.