Cataract Surgery and Infections

In my opinion, cataract surgery is close to, if not definitively, the most reliably successful thing we do in medicine. So, if someone gets a bad infection after surgery, it’s especially painful for both the patient and the surgeon, who are both expecting great results. Fortunately, infections inside the eyeball after cataract surgery are very rare. However, given the number of cataract surgeries that are done, these infections do crop up. So, as a community of ophthalmologists, we desire to do everything we can to take this rare complication and make it even rarer. One idea that seems to lower the infection rate is the injection of antibiotics into the front of the eye near the end of surgery as routine prevention. An antibiotic that can be used is vancomycin, which has good activity against the bacteria that commonly cause post-cataract surgery infections. However, use of vancomycin has been linked to a complication called HORV (hemorrhagic occlusive retinal vasculitis), which can have even more devastating impacts than the infection vancomycin is meant to prevent. HORV is very rare, but given that it is possible and the infection has a low rate, it is currently controversial whether routine prophylaxis with vancomycin is worth the risk of HORV. These are relatively new things that we are thinking about as eye doctors; I personally have never used this vancomycin prophylaxis. Only time and more studies will give us a better understanding of what to do in the future.