Prophylactic measures used for the prevention of postoperative endophthalmitis after cataract surgery. A survey of routine practice in Yemen

OBJECTIVE: This study documents the current practice of perioperative prophylactic methods used for cataract surgery in Yemen. It investigates the routine practice in antibiotic and antiseptic use in preventing postoperative endophthalmitis.

METHODS: This is a non-comparative survey. A telephone interview survey was conducted with 100 ophthalmologists' from different governorates in Yemen in September 2008. A questionnaire was used to ask the ophthalmic surgeons.

RESULTS: The practices of 100 ophthalmologists were contacted. Five ophthalmologists did not perform cataract surgery routinely. Of the remaining 95 respondents, all performed extracapsular cataract extraction and 5 also performed phacoemulsification. Preoperative topical antibiotics were routinely prescribed by 12 (12.6%) cataract surgeons. Before the start of the procedure, 21 (22.1%) used 10% povidone-iodine to prepare the skin and 5 (5.3%) instilled 5% povidone-iodine in the conjunctival sac. Intracameral antibiotics or antibiotic in the irrigating fluid were not given by any of the surgeons. All gave subconjunctival antibiotics mostly gentamicin. Postoperatively, 25 (26.3%) used a combination steroid and antibiotic eyedrop and 70 (73.7%) gave a separate eyedrop and 39 (41.1%) gave systemic antibiotics.

CONCLUSION: This study reveals a wide variation of prophylactic measures used by Yemeni ophthalmologists. All surgeons used intraoperative subconjunctival gentamicin and postoperative topical antibiotic. A significant majority (94.7%) are failing to use preoperative conjunctival povidone-iodine, despite its widespread acceptance as the only convincingly proven prophylactic method. The routine practices adopted reflect personal preferences, and were not necessarily evidence-based.