Bacterial endophthalmitis prophylaxis for cataract surgery: an evidence-based update.

PURPOSE To assess commonly used cataract surgery bacterial endophthalmitis prophylaxis techniques based on a systematic literature review and evidence rating. CLINICAL RELEVANCE Prophylactic techniques to decrease the risk of bacterial endophthalmitis related to cataract surgery are commonly used, but the evidence justifying their use is unclear. LITERATURE REVIEWED A MEDLINE search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. Eighty-eight peer-reviewed papers were identified and judged worthy of review on the basis of predefined criteria. RESULTS No prophylactic technique received the highest of three possible clinical recommendations (A, crucial to clinical outcome). Preoperative povidone-iodine preparation received the intermediate clinical recommendation (B, moderately important to clinical outcome). All other reported prophylactic interventions, including postoperative subconjunctival antibiotic injection, preoperative lash trimming, preoperative saline irrigation, preoperative topical antibiotics, antibiotic-containing irrigating solutions, and the use of intraoperative heparin, received the lowest clinical recommendation (C, possibly relevant but not definitely related to clinical outcome) based on weak and often conflicting evidence justifying their use. CONCLUSIONS With regard to bacterial endophthalmitis prophylaxis in cataract surgery, current literature most strongly supports the use of preoperative povidone-iodine antisepsis.