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??
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.
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.
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.