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1932338 tn?1349220398

cataract surgery

OK, I just went to a third Cataract Specialist and got a third conflicting opinion on a very important aspect of their Cataract Surgery.  Would one of the forum Doctors please try to enlighten me on this?     (And/or Jodie)

Brief history:
I'm only 57; had 20/20 vision entire life; completely healthy- no diabetes; waterski daily in Summer.  
My Left eye developed ERM last year out of no where.  Had ERM / ILM Vitrectomy May 2011.  Letting Retina "settle down" with inflammation so meanwhile doing my Cataract Surgeon homework.  Now have 3+ Cataract in surgery eye with Right eye only Trace Cataract so will leave alone as long as possible.
Right eye (good & dominant eye) a +1 diopter.

Cataract Specialist #1:  Recommends target Plano.  Does NOT do intracameral antibiotic injection at end of Cataract Surgery because "No studies have proven it to be effective".

Cataract Specialist #2):  His standard procedure is intracameral Ceftazidime antib. injection at end of surgery.

Cataract Specialist #3):  His standard procedure is intracameral Vancomycin antib. injection at end of surgery.  I asked why he doesn't use Ceftazidime, and he stated "that was used in a useless European study" .

I proceeded to ask if a Post-Vitrectomy patient, like myself, would want any intracameral antibiotic injection at all since I read that  the thinner Saline in my eye drastically shortens the half life of the antibiotic as well as allows the antib. to settle on the Retina hence risking toxicity to the Retina.
The Doc seemed to agree with my findings, but blew me off by saying "yes, there are addtl. risks but I want you to have the injection anyways".

Is this all about the Surgeons liability here at the risk of my Retina health ?  Can you shed any light on the subject, please?
Thank you for any and all information you can provide me on the subject.

4 Responses
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1932338 tn?1349220398
That was a wonderfully complete and thoughtful answer Dr. O.  Thank you for taking the time to explain.

Big decision time for me because the two best Cataract Surgeons in Seattle area that handle Complex Cat. Surg. cases are the two who use the Antibiotic Intracameral injections.  Perhaps its just mostly for their liability reasons, but regardless-- that is their protocol.    What to do... What to do ?

  Do I NOT go to one of them because of the potential retina toxicity from either the Ceftazidime or Vancomycin injections?  

I know you cannot keep answering questions Dr. O, but if it were you, what would you do??
Helpful - 0
711220 tn?1251891127
MEDICAL PROFESSIONAL
There are no matched controlled studies to show antibiotics prevent infection.

It is just the standard of care.

I have used Vancomycin in the irrigating bottle years ago but stopped.  The problem with putting antibiotic into the eyes is the dilution.  Dilution error cause the toxicity problem.

Many doctors now inject Vigamox (no preservative) into the anterior chamber at the end of the case and it seems to be safe.

There are not studies that show this is effective.

My surgeon did not inject antibiotics into the anterior chamber when I had my cataract surgery after a few vitrectomies.

Dr. O.

Dr. O.
Helpful - 0
1932338 tn?1349220398
Dear Dr. O,
Thank you for your quick response.

Am I understanding you correctly that the intracameral injection of either of the above mentioned antibiotics, is used safely for once an infection is detected rather than as a routine "Preventative" injection into the vitreous ?

Might I be correct in then assuming that the Surgeons that use them as preventative injections into the vitreous, especially on a vitrectomy patient, could perhaps be doing it for other reasons than the patients best interest?

Could you please point me to some reputable research that might help me make an informed decision as to whether to go with one of these surgeons and potentially risk my Retina health...or, am I over-reacting to the toxicity of these injections on the Retina?

Thank you again, as I'm sure this information will be helpful to others on this forum as well.  When something like this is controversial, I believe the patients should make informed decisions.      
Do you personally endorse either of these injections ?  And to be clear, these surgeons are NOT doing them in the case of an infection,,,they are using them as standard surgical procedure to "prevent" infection.
Helpful - 0
711220 tn?1251891127
MEDICAL PROFESSIONAL
Unfortunately, many consider the European study to be flawed (could be a US perspective).  Some feel antibiotics make no difference.

These antibiotic are injected directly into the vitreous is there is an infection.  They are safe to inject in the anterior segment of the eye.

Dr. O.
Helpful - 0
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