Management
6
Infection Prophylaxis
Î Careful watertight incision construction and closure (with or without
sutures) is obligatory, irrespective of surgical style, because the
incidence of infection increases with wound leak. (II-, M, S)
Î Several studies support the safety of intracameral moxifloxacin
injection for endophthalmitis prophylaxis, and three retrospective
studies suggest efficacy. (I-, G, S)
Î Compared with an intracameral bolus, antibiotic in the infusate has
the theoretical disadvantage of achieving less predictable intraocular
antibiotic concentration and duration, and the practice should be
discouraged. (III, M, S)
Î There is good evidence for the use of a 5% solution of povidone iodine
in the conjunctival cul de sac to prevent infection. (II-, M, S)
Î The surgeon must ensure that antisepsis of the periocular surface,
typically with povidone iodine, is achieved and that all incisions are
closed in a watertight fashion at the end of the procedure. (II-, M, S)
Surgical Technique
Î Only an ophthalmologist has the medical and microsurgical training
as part of a comprehensive resident experience needed to perform
cataract surgery. (III, G, S)
Î When feasible, small-incision surgery is generally preferred for
several reasons. (I+, G, S) Smaller incisions:
• require fewer sutures for secure closure
• are safer in the event of sudden patient movement or a superchoroidal hemorrhage
during surgery
• are associated with less postoperative inflammation
• induce less unwanted astigmatic change than larger incisions
• result in greater long-term stability of the refraction
Femtosecond Laser
Î There may be certain types of cataracts, such as posterior polar or
phacomorphic, for which the femtosecond laser should not be used
due to higher complication rates, such as posterior capsular rupture.
(II-, M, S)
