Tools · Professional education
Cataract Surgery Miscellaneous
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For ophthalmic professionals. Confirm medication preparation, route and dose against local protocols and current product information.
Preventing endophthalmitis
Before surgery
Use an approved periocular and ocular-surface antisepsis protocol. ESCRS recommends povidone-iodine antisepsis with adequate contact time before cataract surgery. Confirm concentration and application instructions for the product and site.
At the end of surgery — intracameral prophylaxis
ESCRS recommends an intracameral antibiotic at the end of cataract surgery; cefuroxime 1 mg in 0.1 mL is a cited example. Check allergy history and use an appropriate sterile intraocular preparation.
Moxifloxacin may be used under an approved local protocol. Formulation, concentration and volume must be checked: FDA has reported toxic anterior segment syndrome with compounded, repackaged or diluted intraocular moxifloxacin.
Use pharmacy-validated preparation instructions for any alternative regimen, including levofloxacin. A topical antibiotic bottle is not automatically suitable for intraocular injection.
Intravitreal antibiotics and antifungals
Suspected endophthalmitis requires urgent ophthalmic assessment and a treatment plan, including sampling and consideration of vitrectomy. The following are reference intravitreal doses, not prophylactic intracameral doses.
Empirical bacterial coverage
- Vancomycin: 1.0 mg / 0.1 mL, plus ceftazidime: 2.25 mg / 0.1 mL.
- Amikacin: 400 µg / 0.1 mL is an alternative in selected circumstances. A penicillin-allergy label alone does not automatically require substitution; assess the actual allergy and retinal-toxicity risk.
Fungal infection — specialist-directed therapy
- Amphotericin B: 5–10 µg / 0.1 mL, or voriconazole: 50–100 µg / 0.1 mL.
Choice depends on the organism and clinical setting; systemic therapy may also be required. Confirm the drug, route, final concentration and volume with the treating specialist and pharmacy.
Pupil not well dilated at surgery
Assess the cause of inadequate dilation and the risk of intraoperative floppy iris syndrome. Review the preoperative response to mydriatics and relevant medication history.
Intracameral mydriatics, including appropriate phenylephrine-containing preparations, may be used under the product label or an approved local protocol. Verify intraocular suitability, excipients and the final dose; do not improvise dilution from topical drops.
If pharmacological dilation is inadequate, consider a suitable pupil-expansion strategy, such as iris hooks or an expansion ring, according to the surgical assessment.