Rachel Xuan, Elizabeth L. S. Wong, Keith Wong

Background: There has been an increase in the use of routine intracameral antibiotics for endophthalmitis pro-phylaxis in cataract surgery. However, this can be associated with serious adverse events. Previously, sub- conjunctival antibiotics were the preferred route but there is minimal literature directly comparing the two. Hence, the safest and most efficacious route of prophylactic antibiotic administration remains controversial.

Purpose: To evaluate the efficacy and safety of sub- conjunctival with intracameral antibiotics for post- operative endophthalmitis (POE) prophylaxis in patients undergoing uncomplicated cataract surgery.

Methods: A literature review was conducted in Cochrane and PubMed for studies that compared the efficacy of prophylactic sub-conjunctival and intracameral antibiotics for post-cataract endophthalmitis. Searches were not limited to English or study design.

Results: Three observational studies showed that sub- conjunctival and intracameral antibiotics both reduced POE rates. Intracameral antibiotics demonstrated a high efficacy (odds ratio 0.25, 95% confidence interval 0.13-0.46, p < 0.0001) but was also associated with increased potential complications. All studies were con- ducted in a sequential nature during which cataract surgery techniques and instrumentation have improved in recent years. Conclusion: In institutions with a high incidence of endophthalmitis, routine intracameral antibiotic use would be more appropriate. However, in facilities with lower rates of POE, the sub-conjunctival route of delivery can be an alternative due to its better safety profile.