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In Reply: We agree with Dr Sauer that topical fourth-generation fluoroquinolones have not been shown in controlled studies to be better than existing agents. To our knowledge, however, there have been no controlled studies in the medical literature that support the use of any topical antibiotic before or after cataract surgery. Given the anticipated very small benefit of topical antibiotics in terms of absolute risk, the sample would need to be prohibitively large to achieve sufficient statistical power and thus such a trial is unlikely ever to be performed. The original study documenting the efficacy of prophylactic antibiotics was poorly controlled, used older-generation antibiotics, and the cataract surgical procedure was very different from today.¹ However, this study demonstrated a reduction in the incidence of endophthalmitis (from 1 in 446 to 1 in 4384) with the use of combination antibiotic therapy, including chloramphenicol.

The incidence of endophthalmitis has been increasing during . . . [Full Text of this Article]

Eric D. Donnenfeld, MD; Renée Solomon, MD
Ophthalmic Consultants of Long Island
Rockville Centre, NY

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Topical Antibiotics Before Cataract Surgery
Stephen Sauer
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