Topical Antibiotic Prophylaxis on the Incidence of Edophthalmitis Following Phacoemulsification Sugery: A Comparison of Gatifloxacin Versus Polymyxin B-Trimethoprim

Purpose: To compare two different perioperative topical antibiotic regimens on the incidence of endophthalmitis following phacoemulsification surgery.

Setting: Lahey Hospital & Medical Center, Peabody, Massachusetts.

Design: Retrospective, consecutive, observational case series.

Methods: The electronic medical records were reviewed for 21,620 consecutive eyes of 13,529 patients undergoing phacoemulsification surgery during an eleven year period from June 2004 to June 2015. All eyes received topical ophthalmic antibiotic drops one hour before surgery. 13,859 consecutive eyes received topical gatifloxacin 0.3% ophthalmic solution and 7,761 consecutive eyes received topical polymyxin B sulfate 10,000 units-trimethoprim 1 mg/ml (PXTM) ophthalmic solution. Pearson chi-squared analyses were performed to examine differences between the two groups.

Results: Over the study period, 5 cases of endophthalmitis occurred among 21,620 (0.023%) eyes following phacoemulsification surgery. The endophthalmitis rate did not differ between patients receiving topical gatifloxacin 0.3% compared to those receiving topical PXTM (0.0216% vs. 0.0258%, N.S.). Three cases of endophthalmitis occurred in 13,859 eyes receiving topical gatifloxacin 0.3% and 2 cases occurred in 7,761 eyes receiving topical PXTM (χ2=0.037, p=0.85). Four cases were Gram positive species and one case yielded no growth. The switch in antibiotic prophylaxis resulted in no adverse events and led to an immediate cost-savings of nearly $80 per case.

Conclusion: Endophthalmitis is rare following phacoemulsification surgery utilizing topical antimicrobial prophylaxis and without additional intracameral prophylaxis. The lack of difference in the rate of endophthalmitis following the switch from topical gatifloxacin 0.3% to PXTM supports the use of the latter, as it is a more cost effective agent.