Ophthalmic surgery antimicrobial prophylaxis

Publication: 30/03/2011  
Next review: 07/01/2025  
Clinical Guideline
CURRENT 
ID: 2335 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.
Be aware: Chlorhexidine is considered an environmental allergen.
Refer to the asepsis guidance.

GUIDELINE FOR ANTIMICROBIAL PROPHYLAXIS AND PREVENTION OF INFECTION FOLLOWING OPHTHALMIC SURGERY IN ADULTS

RECOMMENDED ROUTINE PROPHYLAXIS OPTIONS

Procedure or situation

Antimicrobial dose/route
To be given at the end of surgery unless otherwise stated

Routine

  • MRSA Risk
  • Allergy to Penicillin1,2 or cephalosporin

Cataract surgery

Intra-cameral injection of Cefuroxime Description: electronic Medicines Compendium information on Cefuroxime 1mg in 0.1ml

Intra cameral injection of Vancomycin Description: electronic Medicines Compendium information on Vancomycin 1mg in 0.1ml

For patients with blepharitis, significant epithelial damage or sub-tenons local anaesthetic injection:
Topical Chloramphenicol 0.5 % 6-hourly for 3 days

Penetrating corneal surgery

Intra-cameral injection of Cefuroxime Description: electronic Medicines Compendium information on Cefuroxime 1mg in 0.1ml

Intra cameral injection of Vancomycin Description: electronic Medicines Compendium information on Vancomycin 1mg in 0.1ml

For patients with blepharitis, significant epithelial damage or sub-tenons local anaesthetic injection:
Topical Chloramphenicol 0.5 % 6-hourly for 3 days

Lacrimal Surgery

Chloramphenicol 1% eye ointment single application post operation3

Penetrating eye injury (posterior segment)

Intra vitreal injection of Vancomycin Description: electronic Medicines Compendium information on Vancomycin 1mg in 0.1ml PLUS Ceftazidime Description: electronic Medicines Compendium information on Ceftazidime 2mg in 0.1ml

Intra vitreal injection of Vancomycin Description: electronic Medicines Compendium information on Vancomycin 1mg in 0.1ml PLUS amikacin 0.4mg in 0.1ml

Penetrating ocular injury (anterior segment)

Intra cameral injection of Cefuroxime Description: electronic Medicines Compendium information on Cefuroxime 1mg in 0.1ml

Intra cameral injection of Vancomycin Description: electronic Medicines Compendium information on Vancomycin 1mg in 0.1ml

Squint surgery

Prophylaxis not recommended

Trabeculectomy and other glaucoma surgery

Intra-cameral injection of Cefuroxime Description: electronic Medicines Compendium information on Cefuroxime 1mg in 0.1ml

Intra cameral injection of Vancomycin Description: electronic Medicines Compendium information on Vancomycin 1mg in 0.1ml

 

All patients: Topical chloramphenicol 0.5% 1 drop 6 hourly for 1 week

Pars plana vitrectomy

Intra-cameral injection of Cefuroxime Description: electronic Medicines Compendium information on Cefuroxime 1mg in 0.1ml

Intra cameral injection of Vancomycin Description: electronic Medicines Compendium information on Vancomycin 1mg in 0.1ml

All patients: Topical chloramphenicol 0.5% 1 drop 6 hourly for 1 week

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GENERAL PREVENTATIVE MEASURES

  • Treatment of patients with blepharitis, conjunctivitis and nasolacrimal infections prior to surgery.
  • Povidone iodine solution 5% instilled into the conjunctival sac prior to surgery for at least 3 minutes.
  • Perfect draping technique to isolate the lid margins and lashes from the surgical field avoiding contamination of the surgical gloves and instruments in the process.
  • Non-touch technique as far as possible and rigorous theatre procedures.
  • Surgical masks should be worn by the surgical team during ophthalmic surgery

FOOTNOTES

  1. See “Assessment and Management of a Patient with a History of Penicillin Allergy” for more details on managing penicillin allergies.
  2. For penicillin allergic patients the guidelines state that the risk of an allergic reaction to Cefuroxime in patients with a known allergy to penicillin is present but small and must be weighed up against the increased risk of endophthalmitis if the injection is withheld in these patients. There are case reports of severe anaphylactic reaction attributed to intra-cameral cefuroxime. SIGN guidelines are explicit in the recommendation not to give beta-lactams to patients reporting anaphylaxis to penicillins
  3. If patient has allergy to chloramphenicol or blood dyscrasia use: Fusidic acid 2% eye ointment single application post operation.

Provenance

Record: 2335
Objective:
Clinical condition:

Ophthalmic conditions

Target patient group: Adults
Target professional group(s): Secondary Care Doctors
Pharmacists
Adapted from:

Evidence base

  • SIGN. Antibiotic Prophylaxis in Surgery. Scottish Intercollegiate Guideline Network Publication Number 104. Edinburgh, 2008.
  • Speaker MG, Milch FA, Shah MK, Eisner W, Kreiswirth BN. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 1991;98(5):639-49; discussion 50.
  • Benz MS, Scott IU, Flynn HW, Jr., Unonius N, Miller D. Endophthalmitis isolates and antibiotic sensitivities: a 6-year review of culture-proven cases. Am J Ophthalmol 2004;137(1):38-42.
  • Kamalarajah S, Ling R, Silvestri G, Sharma NK, Cole MD, Cran G, et al. Presumed infectious endophthalmitis following cataract surgery in the UK: a case-control study of risk factors. Eye (Lond) 2007;21(5):580-6.
  • Barry P, Behrens-Baumann W, Pleyer U, Seal D. European Society of cataract and refractive surgery Guidelines on prevention, investigation and management of post-operative endophthalmitis. 2013.
  • Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg 2006;32(3):407-10.
  • Mahiat C, Robaye S, Levecq L, Dumesnil D, Sohy C.  Anaphylactic shock following cataract surgery: a documented intracameral cefuroxime allergy J Investig Allergol Clin Immunol 2022; Vol. 32(3)

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 2.0

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