The effectiveness of antibiotic additives in irrigation fluid used during cataract surgery: A systematic review
Bibliographic record
Abstract
Purpose To conduct a systematic review investigating the efficacy of antibiotics used in irrigation fluid during cataract surgery on the incidence of post-operative endophthalmitis. Design Systematic review of literature. Methods Literature was searched through MEDLINE, EMBASE, CINAHL, Clinical Trials.gov, and ProQuest Dissertations and Theses until February 17, 2024. Conferences held through Association for Research in Vision and Ophthalmology and American Academy of Ophthalmology were searched until March 22, 2024. A total of 5341 records were screened leaving 13. One author independently reviewed them for quality and extracted data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. Data on the types of antibiotics used, as well as the incidence of post-operative endophthalmitis and complications, were extracted. Results A total of 608,064 eyes and 566,760 patients were included in the current study. Surgical procedures included phacoemulsification, manual small-incision, and extracapsular extraction. Results showed antibiotic additives reduced postoperative endophthalmitis and bacterial contamination. Vancomycin showed the lowest infection rates, with one study reporting 0 infections out of 220 patients using a concentration of 20 mg/L. Similarly, gentamicin, tobramycin, and cefuroxime also demonstrated reduced infection rates, with gentamicin achieving rates as low as 0.008% at higher concentrations. Combination therapy with vancomycin and gentamicin further reduced bacterial contamination, with culture positivity rates as low as 2.73%. In comparator groups without antibiotics, infection rates were significantly higher, ranging from 0.04% to 0.07%. No adverse events or complications were reported in those who received antibiotics in their irrigation fluid. Conclusions Antibiotic additives in irrigation fluid reduce postoperative endophthalmitis and bacterial contamination in cataract surgery. These findings support their inclusion in surgical practice to improve patient outcomes. Based on the current systematic review, the overall quality of evidence is moderate, as findings are supported by a mix of randomized controlled trials and observational studies with some heterogeneity. Further high-quality RCTs are needed to determine optimal antibiotic concentrations and establish standardized guidelines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.047 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.011 |
| Bibliometrics | 0.011 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".