Prophylactic Practices Against Endophthalmitis Following Cataract Surgery Among Nigerian Ophthalmologists and a Review of Evidence

Abstract

Background: This study examined the prophylaxis practices against postoperative endophthalmitis among Nigerian ophthalmologists in the perioperative period of cataract surgery and reviewed the evidence for such practices. Materials and methods: A semi-structured self-administered questionnaire survey was conducted on ophthalmic surgeons who attended the annual general meeting of Ophthalmological Society of Nigeria in September 2017 in Kaduna, North West-Nigeria. A search on prophylaxis against endophthalmitis pre-, intra-, and post-cataract surgery was reviewed and a summary made. Results: A total of 150 ophthalmologists were surveyed, 64(42.7%) use preoperative antibiotics with a majority using fluoroquinolones 51(34%), most surgeons 138(92.0%) used povidone-iodine to prepare the skin and instilled in the conjunctival sac. Intraoperatively, a large number of surgeons 143(95.3) use sub-conjunctival antibiotic gentamycin at the end of surgery but less intracameral 53(35.3%). The most common intracameral antibiotic used is ceftazidime 32(21.3%). In the postoperative, almost all surgeons 146(97.3%) use antibiotic eyedrop prophylaxis, especially, ciprofloxacin 118(78.7%) for about 3 weeks 84(56%). An evidence review suggests the effectiveness of povidone-iodine ocular surface decontamination and intracameral injection in the prevention of endophthalmitis post-cataract surgery. Conclusion: The predominant methods of prophylaxis are preoperative eye drops and povidone-iodine, intraoperative subconjunctival gentamicin, and postoperative eye drops. Only a few surgeons used Intracameral antibiotic prophylaxis in Nigeria, despite its effectiveness.