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Prevention of postcataract endophthalmitis: evidence-based medicine

Purpose of review To provide a summary of current peer-reviewed publications on the methods of prophylaxis against postcataract endophthalmitis. Recent findings Preoperative application of povidone–iodine remains the standard protocol for the prevention of postoperative endophthalmitis. More recent evidence suggests that intracameral cefuroxime administered at the conclusion of surgery significantly reduces the risk of endophthalmitis. However, its clinical use has been limited because of a lack of commercially available antibiotic indicated for intraocular injection. Although topical antibiotic application continues to be a controversial topic with respect to the types of antibiotic prescribed and dosage, most ophthalmologists do prescribe an antibiotic for the perioperative period. Resistance against antibiotics, including the very popular classes of fluoroquinolones, is rising. Most notably, methicillin resistance continues to increase over time. Summary Prevention of postcataract endophthalmitis remains a difficult topic to study given the low incidence. In addition to appropriate wound construction, a combination of povidone–iodine and antibiotics provide a reasonable approach in reducing the risk of this rare but serious infection.