CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2023; 15(01): e86-e90
DOI: 10.1055/s-0043-1768024
Research Article

Antibiotic Protocols for Endophthalmitis Prophylaxis Following Open-Globe Repair: A Survey of U.S. Residency Programs

David Fell
1   Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, Texas
,
1   Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Funding None.

Abstract

Purpose To assess the various approaches to endophthalmitis prevention following traumatic open-globe injury (OGI) repair.

Methods A research electronic data capture (REDCap) questionnaire evaluating the usage of antibiotics and steroids in patients with OGI was distributed to program directors of all U.S. ophthalmology residency programs using the Association of University Professors of Ophthalmology program directors' listserv. Completed questionnaires were analyzed for treatment patterns.

Results The REDCap questionnaire was distributed to 111 programs, with 32 residency programs responding. Two responses were excluded. Ninety percent (27/30) of included programs used perioperative intravenous (IV) antibiotics, with 78% (21/27) of those giving one dose only. At the time of surgery, 27% (8/30) of programs gave intravitreal antibiotics and 60% (18/30) gave subconjunctival antibiotics. Postoperatively, 100% (30/30) gave topical antibiotics and 97% (29/30) gave topical steroids. Only 53% of responders discharged patients on oral antibiotics. Of the three programs who did not use IV antibiotics, all three gave intravitreal therapy and one also discharged patients on oral antibiotics.

Conclusion There is a large variation in practice patterns for endophthalmitis prophylaxis among residency programs. Further investigation is needed to compare rates of endophthalmitis between these protocols and establish a safe and minimally burdensome standard of care.



Publication History

Received: 24 August 2022

Accepted: 01 March 2023

Article published online:
12 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 May DR, Kuhn FP, Morris RE. et al. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol 2000; 238 (02) 153-157
  • 2 Essex RW, Yi Q, Charles PG, Allen PJ. Post-traumatic endophthalmitis. Ophthalmology 2004; 111 (11) 2015-2022
  • 3 Bhagat N, Nagori S, Zarbin M. Post-traumatic infectious endophthalmitis. Surv Ophthalmol 2011; 56 (03) 214-251
  • 4 Ahmed Y, Schimel AM, Pathengay A, Colyer MH, Flynn Jr HW. Endophthalmitis following open-globe injuries. Eye (Lond) 2012; 26 (02) 212-217
  • 5 Zhang Y, Zhang MN, Jiang CH, Yao Y, Zhang K. Endophthalmitis following open globe injury. Br J Ophthalmol 2010; 94 (01) 111-114
  • 6 Huang JM, Pansick AD, Blomquist PH. Use of intravenous vancomycin and cefepime in preventing endophthalmitis after open globe injury. J Ocul Pharmacol Ther 2016; 32 (07) 437-441
  • 7 Andreoli CM, Andreoli MT, Kloek CE, Ahuero AE, Vavvas D, Durand ML. Low rate of endophthalmitis in a large series of open globe injuries. Am J Ophthalmol 2009; 147 (04) 601-608.e2
  • 8 Du Toit N, Mustak S, Cook C. Randomised controlled trial of prophylactic antibiotic treatment for the prevention of endophthalmitis after open globe injury at Groote Schuur Hospital. Br J Ophthalmol 2017; 101 (07) 862-867
  • 9 Tabatabaei SA, Soleimani M, Behrooz MJ, Sheibani K. Systemic oral antibiotics as a prophylactic measure to prevent endophthalmitis in patients with open globe injuries in comparison with intravenous antibiotics. Retina 2016; 36 (02) 360-365
  • 10 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 11 Shrestha B, Dunn L. The Declaration of Helsinki on medical research involving human subjects: a review of seventh revision. J Nepal Health Res Counc 2020; 17 (04) 548-552
  • 12 Verbraeken H, Rysselaere M. Post-traumatic endophthalmitis. Eur J Ophthalmol 1994; 4 (01) 1-5
  • 13 Duch-Samper AM, Menezo JL, Hurtado-Sarrió M. Endophthalmitis following penetrating eye injuries. Acta Ophthalmol Scand 1997; 75 (01) 104-106
  • 14 Jonas JB, Knorr HL, Budde WM. Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology 2000; 107 (05) 823-828
  • 15 Soheilian M, Rafati N, Mohebbi MR. et al; Traumatic Endophthalmitis Trial Research Group. Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2. Arch Ophthalmol 2007; 125 (04) 460-465
  • 16 Brockhaus L, Goldblum D, Eggenschwiler L, Zimmerli S, Marzolini C. Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics. Clin Microbiol Infect 2019; 25 (11) 1364-1369
  • 17 Durrani AF, Zhao PY, Zhou Y. et al. Risk factors for endophthalmitis following open globe injuries: a 17-year analysis. Clin Ophthalmol 2021; 15: 2077-2087
  • 18 Narang S, Gupta V, Gupta A, Dogra MR, Pandav SS, Das S. Role of prophylactic intravitreal antibiotics in open globe injuries. Indian J Ophthalmol 2003; 51 (01) 39-44
  • 19 Abouammoh MA, Al-Mousa A, Gogandi M. et al. Prophylactic intravitreal antibiotics reduce the risk of post-traumatic endophthalmitis after repair of open globe injuries. Acta Ophthalmol 2018; 96 (03) e361-e365