In Reply We agree that there are limited evidence-based data indicating that perioperative topical antibiotics reduce rates of endophthalmitis following cataract surgery.1 As previously discussed, the use of perioperative topical povidone-iodine, an eyelid speculum and drape with isolation of the eyelids and eyelashes, and meticulous sterile preparation and procedures is effective in limiting the incidence of endophthalmitis in these patients.2 It is unlikely that a large-scale randomized prospective trial to evaluate the use of perioperative topical antibiotics could be performed because the rates of endophthalmitis are very low. Furthermore, other risk factors including rupture of the posterior capsule, anterior vitrectomy, diabetes mellitus, and older age may be more important for the development of postoperative endophthalmitis. In a somewhat similar model used by vitreoretinal specialists, periprocedural topical antibiotics do not appear to reduce the risk of endophthamitis following intravitreal injections.3 Topical antibiotics may promote the emergence of antimicrobial resistance, leading to the potential of endophthalmitis caused by more virulent organisms.4
Schimel AM, Alfonso E, Flynn HW. Controversial Role of Topical Antibiotics in Endophthalmitis Prophylaxis for Cataract Surgery—Reply. JAMA Ophthalmol. 2015;133(4):491. doi:10.1001/jamaophthalmol.2014.5326
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